Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for...

Dr Arjun Rajagopalan

BIOPSYBIOPSY


BIOPSY We know … • Colonic cancer is the most common cause

of acute large bowel obstruction. • Emergency surgery, often with creation of a

stoma, is the recommended treatment. • In recent years, self-expanding metallic

stents have been used to provide a “bridge to surgery” permitting a single-stage resection under elective conditions.

We don’t know … • Are long-term outcome for patients treated

with stents acceptable?


BIOPSY 1: Population

Meta-analysis of studies on colorectal cancer culled from an extensive search of medical databases until May 2014.

1136 patients

Search results

11436

RejectedAccepted

Treatment

704 432 StentEmergency

RCT with > 3 yrs follow up


BIOPSY3: Outcome

variable

2: Indicator variable

4: Comparison

5 yr - overall survival

Disease-free survival

Recurrence

17.5% 35% 52.5% 70%

27.2%

59%

67.1%

31.3%

48.4%

57.2%

Stent - Bridge to surgeryImmediate surgery

No statistically significant differences


BIOPSY The author(s) conclude … Results of this meta-analysis on long-term as well as well-described short-term outcomes suggest that expanding metallic stent insertion as a “bridge to surgery" could be a promising alternative strategy for malignant large bowel obstruction patients.

METHODOLOGYType of study Review

SAMPLINGCentre University hospital, JapanTIme frame Up to May 2014Analysis Meta-analysis

A priori samplesize calculation -

Exclusions Lack of survival data Palliative surgery

Numbers 1136 patients

COMPARISONControls ✅

Randomization ✅

Protocols/ training ✅

Comparability of groups ✅

MEASUREMENTTraining -Blinding -Multiple observers -Duplication -

Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for...

Health & Medicine

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