Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials
Background Despite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern. Aim The aim of this meta-anal...
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| Veröffentlicht in: | Surgical endoscopy 2019-01, Vol.33 (1), p.293-302 |
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| creator | Foo, Chi Chung Poon, Samuel Ho Ting Chiu, Rosemaire Hon Yiu Lam, Wai Yiu Cheung, Lam Chi Law, Wai Lun |
| description | Background
Despite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern.
Aim
The aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).
Methods
Randomized control trials (RCTs) comparing BTS stent and EmS for left-sided colonic obstruction caused by primary cancer of the colon, up to Sep 2018, were retrieved from the Pubmed, Embase database, clinical trials registry of U. S. National Library of Medicine and BMJ and Google Search.
Results
There were seven eligible RCTs, involving a total of 448 patients. Compared to EmS, BTS stent had a significantly lower risk of overall complications (RR = 0.605; 95% CI 0.382–0.958;
p
= 0.032). However, the overall recurrence rate was higher in the BTS stent group (37.0% vs. 25.9%; RR = 1.425; 95% CI 1.002–2.028;
p
= 0.049). BTS stent significantly increased the risk of systemic recurrence (RR = 1.627; 95% CI 1.009–2.621;
p
= 0.046). This did not translate into a significant difference in terms of 3-year disease-free survival or 3-year overall survival.
Conclusion
BTS stent is associated with a lower rate of overall morbidities than EmS. However, BTS stent was associated with a greater chance of recurrence, especially systemic recurrence. Clinicians ought to be aware of the pros and cons of different interventions and tailor treatments for patients suffering from left-sided obstructing cancer of the colon. |
| doi_str_mv | 10.1007/s00464-018-6487-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_2123723961</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2122917822</sourcerecordid><originalsourceid>FETCH-LOGICAL-p212t-e91adaab422c8d3e6a961199ead108d426a4e26dd19961d24411ee0f05b33bab3</originalsourceid><addsrcrecordid>eNpdkc1qHDEQhEWwiTdOHiAXI_AlF8X688wot2DyYzDk4pxFz6h3kdFIa0lj2DyHH9iyd-NATg3dX1VDFSEfBf8sOO8vCue604yLgXV66Jl6Q1ZCK8mkFMMRWXGjOJO90SfkXSl3vOFGXL4lJ4orLTptVuTxutAxe7dBWhMtS95g3tFSMVYfNxRogTVSCBVzhOofXjCcsXFx2r0KfKQzBL-JECudUkjRTzSNpeZlqj7FL81pxgoMIoRd8YWmNc0QXZr9H3RNEmtOgdbsIZT35HjdBn44zFPy-_u326uf7ObXj-urrzdsK4WsDI0ABzBqKafBKezAdEIYg-AEH5yWHWiUnXNt1wkntRYCka_55ajUCKM6JZ_2vtuc7hcs1c6-TBgCRExLse2L6qVq4oae_4fepaVFEl4oaUQ_SNmoswO1jDM6u81-hryzf_NugNwDpZ1ii-6fjeD2uVS7L9W2Uu1zqVapJ1zdlM8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2122917822</pqid></control><display><type>article</type><title>Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Foo, Chi Chung ; Poon, Samuel Ho Ting ; Chiu, Rosemaire Hon Yiu ; Lam, Wai Yiu ; Cheung, Lam Chi ; Law, Wai Lun</creator><creatorcontrib>Foo, Chi Chung ; Poon, Samuel Ho Ting ; Chiu, Rosemaire Hon Yiu ; Lam, Wai Yiu ; Cheung, Lam Chi ; Law, Wai Lun</creatorcontrib><description>Background
Despite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern.
Aim
The aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).
Methods
Randomized control trials (RCTs) comparing BTS stent and EmS for left-sided colonic obstruction caused by primary cancer of the colon, up to Sep 2018, were retrieved from the Pubmed, Embase database, clinical trials registry of U. S. National Library of Medicine and BMJ and Google Search.
Results
There were seven eligible RCTs, involving a total of 448 patients. Compared to EmS, BTS stent had a significantly lower risk of overall complications (RR = 0.605; 95% CI 0.382–0.958;
p
= 0.032). However, the overall recurrence rate was higher in the BTS stent group (37.0% vs. 25.9%; RR = 1.425; 95% CI 1.002–2.028;
p
= 0.049). BTS stent significantly increased the risk of systemic recurrence (RR = 1.627; 95% CI 1.009–2.621;
p
= 0.046). This did not translate into a significant difference in terms of 3-year disease-free survival or 3-year overall survival.
Conclusion
BTS stent is associated with a lower rate of overall morbidities than EmS. However, BTS stent was associated with a greater chance of recurrence, especially systemic recurrence. Clinicians ought to be aware of the pros and cons of different interventions and tailor treatments for patients suffering from left-sided obstructing cancer of the colon.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6487-3</identifier><identifier>PMID: 30341649</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2018 EAES Oral ; Abdominal Surgery ; Anastomosis, Surgical - adverse effects ; Anastomosis, Surgical - statistics & numerical data ; Clinical trials ; Colorectal cancer ; Colorectal Neoplasms - complications ; Colorectal Neoplasms - surgery ; Disease-Free Survival ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Intestinal obstruction ; Intestinal Obstruction - surgery ; Medicine ; Medicine & Public Health ; Meta-analysis ; Ostomy ; Proctology ; Randomized Controlled Trials as Topic ; Stents ; Stents - adverse effects ; Surgery ; Survival Analysis</subject><ispartof>Surgical endoscopy, 2019-01, Vol.33 (1), p.293-302</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Surgical Endoscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-p212t-e91adaab422c8d3e6a961199ead108d426a4e26dd19961d24411ee0f05b33bab3</cites><orcidid>0000-0001-8849-6597</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6487-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6487-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30341649$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Foo, Chi Chung</creatorcontrib><creatorcontrib>Poon, Samuel Ho Ting</creatorcontrib><creatorcontrib>Chiu, Rosemaire Hon Yiu</creatorcontrib><creatorcontrib>Lam, Wai Yiu</creatorcontrib><creatorcontrib>Cheung, Lam Chi</creatorcontrib><creatorcontrib>Law, Wai Lun</creatorcontrib><title>Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Despite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern.
Aim
The aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).
Methods
Randomized control trials (RCTs) comparing BTS stent and EmS for left-sided colonic obstruction caused by primary cancer of the colon, up to Sep 2018, were retrieved from the Pubmed, Embase database, clinical trials registry of U. S. National Library of Medicine and BMJ and Google Search.
Results
There were seven eligible RCTs, involving a total of 448 patients. Compared to EmS, BTS stent had a significantly lower risk of overall complications (RR = 0.605; 95% CI 0.382–0.958;
p
= 0.032). However, the overall recurrence rate was higher in the BTS stent group (37.0% vs. 25.9%; RR = 1.425; 95% CI 1.002–2.028;
p
= 0.049). BTS stent significantly increased the risk of systemic recurrence (RR = 1.627; 95% CI 1.009–2.621;
p
= 0.046). This did not translate into a significant difference in terms of 3-year disease-free survival or 3-year overall survival.
Conclusion
BTS stent is associated with a lower rate of overall morbidities than EmS. However, BTS stent was associated with a greater chance of recurrence, especially systemic recurrence. Clinicians ought to be aware of the pros and cons of different interventions and tailor treatments for patients suffering from left-sided obstructing cancer of the colon.</description><subject>2018 EAES Oral</subject><subject>Abdominal Surgery</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Anastomosis, Surgical - statistics & numerical data</subject><subject>Clinical trials</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - complications</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Disease-Free Survival</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Intestinal obstruction</subject><subject>Intestinal Obstruction - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Ostomy</subject><subject>Proctology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Stents</subject><subject>Stents - adverse effects</subject><subject>Surgery</subject><subject>Survival Analysis</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkc1qHDEQhEWwiTdOHiAXI_AlF8X688wot2DyYzDk4pxFz6h3kdFIa0lj2DyHH9iyd-NATg3dX1VDFSEfBf8sOO8vCue604yLgXV66Jl6Q1ZCK8mkFMMRWXGjOJO90SfkXSl3vOFGXL4lJ4orLTptVuTxutAxe7dBWhMtS95g3tFSMVYfNxRogTVSCBVzhOofXjCcsXFx2r0KfKQzBL-JECudUkjRTzSNpeZlqj7FL81pxgoMIoRd8YWmNc0QXZr9H3RNEmtOgdbsIZT35HjdBn44zFPy-_u326uf7ObXj-urrzdsK4WsDI0ABzBqKafBKezAdEIYg-AEH5yWHWiUnXNt1wkntRYCka_55ajUCKM6JZ_2vtuc7hcs1c6-TBgCRExLse2L6qVq4oae_4fepaVFEl4oaUQ_SNmoswO1jDM6u81-hryzf_NugNwDpZ1ii-6fjeD2uVS7L9W2Uu1zqVapJ1zdlM8</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Foo, Chi Chung</creator><creator>Poon, Samuel Ho Ting</creator><creator>Chiu, Rosemaire Hon Yiu</creator><creator>Lam, Wai Yiu</creator><creator>Cheung, Lam Chi</creator><creator>Law, Wai Lun</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8849-6597</orcidid></search><sort><creationdate>20190101</creationdate><title>Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials</title><author>Foo, Chi Chung ; Poon, Samuel Ho Ting ; Chiu, Rosemaire Hon Yiu ; Lam, Wai Yiu ; Cheung, Lam Chi ; Law, Wai Lun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p212t-e91adaab422c8d3e6a961199ead108d426a4e26dd19961d24411ee0f05b33bab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>2018 EAES Oral</topic><topic>Abdominal Surgery</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Anastomosis, Surgical - statistics & numerical data</topic><topic>Clinical trials</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - complications</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Disease-Free Survival</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Intestinal obstruction</topic><topic>Intestinal Obstruction - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Ostomy</topic><topic>Proctology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Stents</topic><topic>Stents - adverse effects</topic><topic>Surgery</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Foo, Chi Chung</creatorcontrib><creatorcontrib>Poon, Samuel Ho Ting</creatorcontrib><creatorcontrib>Chiu, Rosemaire Hon Yiu</creatorcontrib><creatorcontrib>Lam, Wai Yiu</creatorcontrib><creatorcontrib>Cheung, Lam Chi</creatorcontrib><creatorcontrib>Law, Wai Lun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Foo, Chi Chung</au><au>Poon, Samuel Ho Ting</au><au>Chiu, Rosemaire Hon Yiu</au><au>Lam, Wai Yiu</au><au>Cheung, Lam Chi</au><au>Law, Wai Lun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>33</volume><issue>1</issue><spage>293</spage><epage>302</epage><pages>293-302</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Despite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern.
Aim
The aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).
Methods
Randomized control trials (RCTs) comparing BTS stent and EmS for left-sided colonic obstruction caused by primary cancer of the colon, up to Sep 2018, were retrieved from the Pubmed, Embase database, clinical trials registry of U. S. National Library of Medicine and BMJ and Google Search.
Results
There were seven eligible RCTs, involving a total of 448 patients. Compared to EmS, BTS stent had a significantly lower risk of overall complications (RR = 0.605; 95% CI 0.382–0.958;
p
= 0.032). However, the overall recurrence rate was higher in the BTS stent group (37.0% vs. 25.9%; RR = 1.425; 95% CI 1.002–2.028;
p
= 0.049). BTS stent significantly increased the risk of systemic recurrence (RR = 1.627; 95% CI 1.009–2.621;
p
= 0.046). This did not translate into a significant difference in terms of 3-year disease-free survival or 3-year overall survival.
Conclusion
BTS stent is associated with a lower rate of overall morbidities than EmS. However, BTS stent was associated with a greater chance of recurrence, especially systemic recurrence. Clinicians ought to be aware of the pros and cons of different interventions and tailor treatments for patients suffering from left-sided obstructing cancer of the colon.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30341649</pmid><doi>10.1007/s00464-018-6487-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8849-6597</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2019-01, Vol.33 (1), p.293-302 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | 2018 EAES Oral Abdominal Surgery Anastomosis, Surgical - adverse effects Anastomosis, Surgical - statistics & numerical data Clinical trials Colorectal cancer Colorectal Neoplasms - complications Colorectal Neoplasms - surgery Disease-Free Survival Endoscopy Gastroenterology Gynecology Hepatology Humans Intestinal obstruction Intestinal Obstruction - surgery Medicine Medicine & Public Health Meta-analysis Ostomy Proctology Randomized Controlled Trials as Topic Stents Stents - adverse effects Surgery Survival Analysis |
| title | Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials |
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