Determining the difference in the efficacy and safety of self-expandable metallic stents as a bridge to surgery for obstructive colon cancer among patients in the CROSS 0 group and those in the CROSS 1 or 2 group: a pooled analysis of data from two Japanese prospective multicenter trials

Takeshi Ohki,Mamoru Shimada,Tomonori Yamada,Masakazu Yamamoto,Masafumi Tomita,Takeaki Matsuzawa,Hiroyuki Isayama,Yoshihisa Saida,Koichi Koizumi,Shuji Saito,Tomio Hirakawa,Shuntaro Yoshida,Toshio Kuwai,Toshiyasu Shiratori

doi:10.1007/s00595-020-01970-3

Abstract

PurposeThis study compared the feasibility and safety of endoscopic placement of self-expandable metallic stents (SEMSs) as a bridge to surgery (BTS) between patients with obstructive colorectal cancer (CRC) classified as ColoRectal Obstruction Scoring System (CROSS) 0 and those with CROSS 1 or 2.MethodsWe conducted a post hoc analysis of two prospective, observational, single-arm multicenter clinical trials and performed a pooled analysis of the data. In total, 336 consecutive patients with malignant colorectal obstruction underwent SEMS placement. The primary endpoint was clinical success, defined as resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events.ResultsHigh clinical (98.0% vs. 98.4%) and technical (96.7% vs. 97.8%) success rates were observed in both groups (CROSS 0 vs. CROSS 1 or 2). The adverse event rate was low. The mean stricture length was lower (3.8 ± 1.2 cm vs. 4.4 ± 1.8 cm) and laparoscopic surgery more common (56.7% vs 52.2%) in the CROSS 0 group than in the CROSS 1 and 2 group.ConclusionThis study was the first to compare the degree of stricture in different CROSS groups and demonstrated comparable results with respect to the short-term efficacy and safety of SEMS placement as a BTS for obstructive CRC in CROSS 0, 1, and 2 patients.

Highlights

Endoscopic placement of self-expandable metal stents (SEMSs) has two major indications: to relieve the symptoms of bowel obstruction and restore the bowel function in a palliative setting and to achieve bowel decompression as a bridge to surgery (BTS)
This recommendation is based on the findings of various randomized controlled trials (RCTs) and cohort studies indicating that the success rate of using a self-expandable metallic stents (SEMSs) as BTS was as low as 47% (47–100%), while the perforation rate was as high as 8.7% (0–12.8%) [3,4,5,6,7,8,9,10,11]
This study shows that SEMS placement as a BTS for obstructive colorectal cancer (CRC) has good efficacy and high safety

Summary

Introduction

Endoscopic placement of self-expandable metal stents (SEMSs) has two major indications: to relieve the symptoms of bowel obstruction and restore the bowel function in a palliative setting and to achieve bowel decompression as a bridge to surgery (BTS). Clinical guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) state that SEMSs for BTS may not be safe in colonic obstruction associated with malignancy, especially on the left side of the colon [2]. This recommendation is based on the findings of various randomized controlled trials (RCTs) and cohort studies indicating that the success rate of using a SEMS as BTS was as low as 47% (47–100%), while the perforation rate was as high as 8.7% (0–12.8%) [3,4,5,6,7,8,9,10,11]. SEMS placement for oncological indications appears to affect the long-term prognosis

Methods

Results

Conclusion