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Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials

  • 2018 EAES Oral
  • Published:
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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.

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Acknowledgements

The authors thank Dr. Karen Tung, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China for providing the additional information regarding the long-term results of the study conducted in her center.

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Author notes

  1. Chi Chung Foo and Samuel Ho Ting Poon are co-first authors.

Authors and Affiliations

  1. Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Chi Chung Foo & Wai Lun Law

  2. Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China

    Samuel Ho Ting Poon, Rosemaire Hon Yiu Chiu, Wai Yiu Lam & Lam Chi Cheung

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  1. Chi Chung Foo
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Correspondence to Chi Chung Foo.

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Disclosures

Drs. Chi Chung Foo, Samuel Ho Ting Poon, Rosemaire Hon Yiu Chiu, Wai Yiu Lam, and Lam Chi Cheung and Professor Wai Lun Law have no conflicts of interest or financial ties to disclose.

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Foo, C.C., Poon, S.H.T., Chiu, R.H.Y. et al. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc 33, 293–302 (2019). https://doi.org/10.1007/s00464-018-6487-3

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  • DOI: https://doi.org/10.1007/s00464-018-6487-3

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