Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis

Femke J. Amelung; Thijs A. Burghgraef; Pieter J. Tanis; Jeanin E. van Hooft; Frank ter Borg; Peter D. Siersema; Willem A. Bemelman; Esther C. J. Consten

doi:10.1016/j.critrevonc.2018.08.003

Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis

Femke J. Amelung, Thijs A. Burghgraef, Pieter J. Tanis, Jeanin E. van Hooft, Frank ter Borg, Peter D. Siersema, Willem A. Bemelman, Esther C. J. Consten^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

52 Citations (Scopus)

Abstract

This meta-analysis aims to determine the long-term oncological outcomes of SEMS as bridge to surgery (BTS) versus emergency surgery (ES). A systematic search without restrictions was conducted, and all studies comparing SEMS with ES reporting on long-term outcomes were included. Methodological quality was assessed using the appropriate tools. Twenty-one comparative studies were selected, reporting on 1919 patients. Meta-analysis showed no significant difference regarding three- and five-year overall survival (OR = 0-85 (0.68-1-08) and OR = 1.04 (0.68-1.57), respectively), disease-free survival (OR = 0.96 (0.73-1.26) and OR = 0.86 (0.54-1-36), respectively) and local recurrence rate (OR = 1.32 (0.78-2.23)). Permanent stomas were significantly lower in the SEMS group (OR 0.49 (0-32-0-74)). Sensitivity analysis on three-year survival showed opposite outcomes, with a trend towards worse survival in the SEMS group when only RCTs are taken into account. In conclusion, when in experienced hands, SEMS placement as BTS seems oncologically safe.

Original language	English
Pages (from-to)	66-75
Number of pages	10
Journal	Critical Reviews in Oncology/Hematology
Volume	131
DOIs	https://doi.org/10.1016/j.critrevonc.2018.08.003
Publication status	Published - Nov-2018
Externally published	Yes

Keywords

Colon cancer
Colonic obstruction
Stent
SEMS
Emergency surgery
Survival
LONG-TERM OUTCOMES
EXPANDING METALLIC STENTS
LARGE-BOWEL OBSTRUCTION
MALIGNANT COLORECTAL OBSTRUCTION
EMERGENCY-SURGERY
LAPAROSCOPIC APPROACH
ELECTIVE SURGERY
MANAGEMENT
PLACEMENT
PERFORATION

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Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis
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Amelung, F. J., Burghgraef, T. A., Tanis, P. J., van Hooft, J. E., ter Borg, F., Siersema, P. D., Bemelman, W. A., & Consten, E. C. J. (2018). Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Critical Reviews in Oncology/Hematology, 131, 66-75. https://doi.org/10.1016/j.critrevonc.2018.08.003

@article{be601072ce504f68b2b54153286824f7,

title = "Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis",

abstract = "This meta-analysis aims to determine the long-term oncological outcomes of SEMS as bridge to surgery (BTS) versus emergency surgery (ES). A systematic search without restrictions was conducted, and all studies comparing SEMS with ES reporting on long-term outcomes were included. Methodological quality was assessed using the appropriate tools. Twenty-one comparative studies were selected, reporting on 1919 patients. Meta-analysis showed no significant difference regarding three- and five-year overall survival (OR = 0-85 (0.68-1-08) and OR = 1.04 (0.68-1.57), respectively), disease-free survival (OR = 0.96 (0.73-1.26) and OR = 0.86 (0.54-1-36), respectively) and local recurrence rate (OR = 1.32 (0.78-2.23)). Permanent stomas were significantly lower in the SEMS group (OR 0.49 (0-32-0-74)). Sensitivity analysis on three-year survival showed opposite outcomes, with a trend towards worse survival in the SEMS group when only RCTs are taken into account. In conclusion, when in experienced hands, SEMS placement as BTS seems oncologically safe.",

keywords = "Colon cancer, Colonic obstruction, Stent, SEMS, Emergency surgery, Survival, LONG-TERM OUTCOMES, EXPANDING METALLIC STENTS, LARGE-BOWEL OBSTRUCTION, MALIGNANT COLORECTAL OBSTRUCTION, EMERGENCY-SURGERY, LAPAROSCOPIC APPROACH, ELECTIVE SURGERY, MANAGEMENT, PLACEMENT, PERFORATION",

author = "Amelung, {Femke J.} and Burghgraef, {Thijs A.} and Tanis, {Pieter J.} and {van Hooft}, {Jeanin E.} and {ter Borg}, Frank and Siersema, {Peter D.} and Bemelman, {Willem A.} and Consten, {Esther C. J.}",

year = "2018",

month = nov,

doi = "10.1016/j.critrevonc.2018.08.003",

language = "English",

volume = "131",

pages = "66--75",

journal = "Critical Reviews in Oncology/Hematology",

issn = "1040-8428",

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Amelung, FJ, Burghgraef, TA, Tanis, PJ, van Hooft, JE, ter Borg, F, Siersema, PD, Bemelman, WA & Consten, ECJ 2018, 'Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis', Critical Reviews in Oncology/Hematology, vol. 131, pp. 66-75. https://doi.org/10.1016/j.critrevonc.2018.08.003

TY - JOUR

T1 - Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis

AU - Amelung, Femke J.

AU - Burghgraef, Thijs A.

AU - Tanis, Pieter J.

AU - van Hooft, Jeanin E.

AU - ter Borg, Frank

AU - Siersema, Peter D.

AU - Bemelman, Willem A.

AU - Consten, Esther C. J.

PY - 2018/11

Y1 - 2018/11

N2 - This meta-analysis aims to determine the long-term oncological outcomes of SEMS as bridge to surgery (BTS) versus emergency surgery (ES). A systematic search without restrictions was conducted, and all studies comparing SEMS with ES reporting on long-term outcomes were included. Methodological quality was assessed using the appropriate tools. Twenty-one comparative studies were selected, reporting on 1919 patients. Meta-analysis showed no significant difference regarding three- and five-year overall survival (OR = 0-85 (0.68-1-08) and OR = 1.04 (0.68-1.57), respectively), disease-free survival (OR = 0.96 (0.73-1.26) and OR = 0.86 (0.54-1-36), respectively) and local recurrence rate (OR = 1.32 (0.78-2.23)). Permanent stomas were significantly lower in the SEMS group (OR 0.49 (0-32-0-74)). Sensitivity analysis on three-year survival showed opposite outcomes, with a trend towards worse survival in the SEMS group when only RCTs are taken into account. In conclusion, when in experienced hands, SEMS placement as BTS seems oncologically safe.

AB - This meta-analysis aims to determine the long-term oncological outcomes of SEMS as bridge to surgery (BTS) versus emergency surgery (ES). A systematic search without restrictions was conducted, and all studies comparing SEMS with ES reporting on long-term outcomes were included. Methodological quality was assessed using the appropriate tools. Twenty-one comparative studies were selected, reporting on 1919 patients. Meta-analysis showed no significant difference regarding three- and five-year overall survival (OR = 0-85 (0.68-1-08) and OR = 1.04 (0.68-1.57), respectively), disease-free survival (OR = 0.96 (0.73-1.26) and OR = 0.86 (0.54-1-36), respectively) and local recurrence rate (OR = 1.32 (0.78-2.23)). Permanent stomas were significantly lower in the SEMS group (OR 0.49 (0-32-0-74)). Sensitivity analysis on three-year survival showed opposite outcomes, with a trend towards worse survival in the SEMS group when only RCTs are taken into account. In conclusion, when in experienced hands, SEMS placement as BTS seems oncologically safe.

KW - Colon cancer

KW - Colonic obstruction

KW - Stent

KW - SEMS

KW - Emergency surgery

KW - Survival

KW - LONG-TERM OUTCOMES

KW - EXPANDING METALLIC STENTS

KW - LARGE-BOWEL OBSTRUCTION

KW - MALIGNANT COLORECTAL OBSTRUCTION

KW - EMERGENCY-SURGERY

KW - LAPAROSCOPIC APPROACH

KW - ELECTIVE SURGERY

KW - MANAGEMENT

KW - PLACEMENT

KW - PERFORATION

U2 - 10.1016/j.critrevonc.2018.08.003

DO - 10.1016/j.critrevonc.2018.08.003

M3 - Review article

VL - 131

SP - 66

EP - 75

JO - Critical Reviews in Oncology/Hematology

JF - Critical Reviews in Oncology/Hematology

SN - 1040-8428

ER -