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 journalReview articleAcademicpeer-review

34 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 languageEnglish
Pages (from-to)66-75
Number of pages10
JournalCritical Reviews in Oncology/Hematology
Volume131
DOIs
Publication statusPublished - Nov-2018
Externally publishedYes

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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