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Techniques in Coloproctology

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01-02-2021 | Colon Cancer | Review

Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis

Authors: I. Balciscueta, Z. Balciscueta, N. Uribe, E. García-Granero

Published in: Techniques in Coloproctology | Issue 2/2021

Abstract

Background

In recent years, there has been growing concern about the potential association of stent placement as a bridge to surgery in malignant colon obstruction and some anatomopathological findings that could lead to worsening long-term cancer outcomes, such as perineural, vascular and lymphatic invasion. The aim of the present review was to assess the pathological changes found in surgical specimens after stent placement for obstructing colon cancer vs. emergency surgery, and the impact of perineural invasion on survival rates

Methods

MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed four meta-analyses to estimate the pooled effect sizes using a random effect model. The outcomes were perineural, vascular and lymphatic invasion rates, and 5-year overall survival rate in patients with obstructive colon cancer, depending on the presence or absence of perineural invasion.

Results

Ten studies with a total of 1273 patients were included in the meta-analysis. We found that patients in the stent group had a significantly higher risk of perineural (OR 1.98, 95% CI 1.22–3.21; p = 0.006) and lymphatic invasion (OR 1.45, 95% CI 1.10–1.90; p = 0.008). Furthermore, patients with positive perineural invasion had almost twice the risk of dying compared to those with no perineural invasion (HR 1.92, 95% CI 1.22–3.02; p = 0.005).

Conclusions

Stent placement as a bridge to surgery in colorectal cancer patients modifies the pathological characteristics such as perineural and lymphatic invasion, and this may worsen the long-term prognosis of patients. The presence of perineural infiltration in obstructed colon cancer decreases the long-term survival of patients.

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Yang Y, Huang X, Sun J et al (2015) Prognostic value of perineural invasion in colorectal cancer: a meta-analysis. J Gastrointest Surg 19(6):1113–1122. https://doi.org/10.1007/s11605-015-2761-zCrossRefPubMed

Knijn N, Mogk SC, Teerenstra S, Simmer F, Nagtegaal ID (2016) Perineural invasion is a strong prognostic factor in colorectal cancer: a systematic review. Am J Surg Pathol 40(1):103–112. https://doi.org/10.1097/PAS.0000000000000518CrossRefPubMed

Yuan H, Dong Q, Zheng B, Hu X, Xu JB, Tu S (2017) Lymphovascular invasion is a high risk factor for stage I/II colorectal cancer: a systematic review and meta-analysis. Oncotarget 8(28):46565–46579. https://doi.org/10.18632/oncotarget.15425CrossRefPubMedPubMedCentral

Harris EI, Lewin DN, Wang HL et al (2008) Lymphovascular invasion in colorectal cancer: an interobserver variability study. Am J Surg Pathol 32(12):1816–1821. https://doi.org/10.1097/PAS.0b013e3181816083CrossRefPubMedPubMedCentral

Liebig C, Ayala G, Wilks JA, Berger DH, Albo D (2009) Perineural invasion in cancer: a review of the literature. Cancer 115(15):3379–3391. https://doi.org/10.1002/cncr.24396CrossRefPubMed

van Wyk HC, Going J, Horgan P, McMillan DC (2017) The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: a systematic review. Crit Rev Oncol Hematol 112:11–20. https://doi.org/10.1016/j.critrevonc.2017.02.005CrossRefPubMed

Nozawa H, Morikawa T, Kawai K et al (2019) Obstruction is associated with perineural invasion in T3/T4 colon cancer. Colorectal Dis 21(8):917–924. https://doi.org/10.1111/codi.14655CrossRefPubMed

Mulcahy HE, Skelly MM, Husain A, O'Donoghue DP (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83(1):46–50. https://doi.org/10.1002/bjs.1800830114CrossRefPubMed

Biondo S, Gálvez A, Ramírez E, Frago R, Kreisler E (2019) Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol 23(12):1141–1161. https://doi.org/10.1007/s10151-019-02110-xCrossRefPubMed

10.

Haraguchi N, Ikeda M, Miyake M et al (2016) Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages. Surg Today 46(11):1310–1317. https://doi.org/10.1007/s00595-016-1333-5CrossRefPubMed

11.

Kang SI, Oh HK, Yoo JS et al (2018) Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncol 27(2):216–224. https://doi.org/10.1016/j.suronc.2018.04.002CrossRefPubMed

12.

Kim HJ, Choi GS, Park JS, Park SY, Jun SH (2013) Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis 28(3):407–414. https://doi.org/10.1007/s00384-012-1556-xCrossRefPubMed

13.

Kim MK, Kye BH, Lee IK et al (2017) Outcome of bridge to surgery stenting for obstructive left colon cancer. ANZ J Surg 87(12):E245–E250. https://doi.org/10.1111/ans.13525CrossRefPubMed

14.

Sabbagh C, Chatelain D, Trouillet N et al (2013) Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc 27(10):3622–3631. https://doi.org/10.1007/s00464-013-2934-3CrossRefPubMed

15.

Wang B, Lu S, Song Z et al (2020) Comparison of clinical outcomes and pathological characteristics of self-expandable stent bridge to surgery and emergency surgery in obstructive colon cancer. Cancer Manag Res 12:1725–1732. https://doi.org/10.2147/CMAR.S233456CrossRefPubMedPubMedCentral

16.

van Hooft JE, Veld JV, Arnold D et al (2020) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—Update 2020. Endoscopy 52(5):389–407. https://doi.org/10.1055/a-1140-3017CrossRefPubMed

17.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100CrossRefPubMedPubMedCentral

18.

Sterne JA, Hernán MA, Reeves BC et al (2016) (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919CrossRefPubMedPubMedCentral

19.

McGuinness LA, Higgins JPT (2020) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. https://doi.org/10.1002/jrsm.1411CrossRefPubMed

20.

Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16. https://doi.org/10.1186/1745-6215-8-16CrossRefPubMedPubMedCentral

21.

Higgins JPT, Green S (editors) (2019) Cochrane Handbook for Systematic Reviews of Interventions Version 6 [updated July 2019]. The Cochrane Collaboration. https://training.cochrane.org/handbooks

22.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13CrossRefPubMedPubMedCentral

23.

Brok J, Thorlund K, Gluud C, Wetterslev J (2008) Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol 61(8):763–769. https://doi.org/10.1016/j.jclinepi.2007.10.007CrossRefPubMed

24.

Cao Y, Yang M, Yan L et al (2020) Colon metal stents as a bridge to surgery had no significant effects on the perineural invasion: a retrospective study. World J Surg Oncol 18(1):77. https://doi.org/10.1186/s12957-020-01845-4CrossRefPubMedPubMedCentral

25.

Kim SJ, Kim HW, Park SB et al (2015) Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc 29(12):3499–3506. https://doi.org/10.1007/s00464-015-4100-6CrossRefPubMed

26.

Kye BH, Lee YS, Cho HM et al (2016) Comparison of long-term outcomes between emergency surgery and bridge to surgery for malignant obstruction in right-sided colon cancer: a multicenter retrospective study. Ann Surg Oncol 23(6):1867–1874. https://doi.org/10.1245/s10434-015-5053-7CrossRefPubMed

27.

Yang SY, Park YY, Han YD et al (2019) Oncologic outcomes of self-expandable metallic stent as a bridge to surgery and safety and feasibility of minimally invasive surgery for acute malignant colonic obstruction. Ann Surg Oncol 26(9):2787–2796. https://doi.org/10.1245/s10434-019-07346-3CrossRefPubMed

28.

Fujita S, Shimoda T, Yoshimura K, Yamamoto S, Akasu T, Moriya Y (2003) Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol 84(3):127–131. https://doi.org/10.1002/jso.10308CrossRefPubMed

29.

Hari DM, Leung AM Lee JH, et al (2013) AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment. J Am Coll Surg. 217(2):181‐190. 10.1016/j.jamcollsurg.2013.04.018

30.

Fryer E, Gorissen KJ, Wang LM, Guy R, Chetty R (2015) Spectrum of histopathological changes encountered in stented colorectal carcinomas. Histopathology 66(4):480–484. https://doi.org/10.1111/his.12467CrossRefPubMed

31.

Sun Q, Liu T, Liu P et al (2019) Perineural and lymphovascular invasion predicts for poor prognosis in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery. J Cancer. 10(10):2243–2249. https://doi.org/10.7150/jca.31473CrossRefPubMedPubMedCentral

32.

Compton CC (2007) Optimal pathologic staging: defining stage II disease. Clin Cancer Res 13(22 Pt 2):6862s–s6870. https://doi.org/10.1158/1078-0432.CCR-07-1398CrossRefPubMed

33.

Quah HM, Chou JF, Gonen M et al (2008) Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum 51(5):503–507. https://doi.org/10.1007/s10350-008-9246-zCrossRefPubMed

34.

Manceau G, Mege D, Bridoux V et al (2019) Emergency s. Dis Colon Rectum 62(8):941–951. https://doi.org/10.1097/DCR.0000000000001421CrossRefPubMed

35.

Spannenburg L, Sanchez Gonzalez M, Brooks A, et al (2020) Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: a systematic review and meta-analysis of high quality prospective and randomised controlled trials [published online ahead of print, 2020 May 7]. Eur J Surg Oncol. 0748–7983(20):30449–2. https://doi.org/10.1016/j.ejso.2020.04.052

36.

Foo CC, Poon SHT, Chiu RHY, Lam WY, Cheung LC, Law WL (2019) 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(1):293–302. https://doi.org/10.1007/s00464-018-6487-3CrossRefPubMed

37.

Matsuda A, Miyashita M, Matsumoto S et al (2015) Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 22(2):497–504. https://doi.org/10.1245/s10434-014-3997-7CrossRefPubMed

38.

De Simone B, Catena F, Coccolini F et al (2017) Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: meta-analysis with systematic review of the literature. World J Meta-Anal 5(1):1–13. https://doi.org/10.13105/wjma.v5.i1.1CrossRef

39.

Ceresoli M, Allievi N, Coccolini F et al (2017) Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol 8(5):867–876. https://doi.org/10.21037/jgo.2017.09.04CrossRefPubMedPubMedCentral

40.

Amelung FJ, Burghgraef TA, Tanis PJ et al (2018) Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol 131:66–75. https://doi.org/10.1016/j.critrevonc.2018.08.003CrossRefPubMed

Title: Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis
Authors: I. Balciscueta
Z. Balciscueta
N. Uribe
E. García-Granero
Publication date: 01-02-2021
Publisher: Springer International Publishing
Keywords: Colon Cancer
Colon Cancer
Published in: Techniques in Coloproctology / Issue 2/2021
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-020-02350-2

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Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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