Long-term outcomes of stent-related perforation in malignant colon obstruction: a systematic review and meta-analysis

Abstract

Purpose

The placement of self-expandable metallic stents as a bridge to surgery in malignant colon obstruction is concerning due to the long-term oncological results reported in recent published studies. The aim of this study was to evaluate the oncological consequences of stent-related perforations in patients with malignant colon obstruction and potentially curable disease.

Methods

MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed five meta-analyses to estimate the pooled effect sizes by using a random-effect model. The outcomes were global, locoregional and systemic recurrence rate and 3 and 5 year-survival rate depending on the presence or absence of stent-related perforation.

Results

Thirteen studies (950 patients) were included. The overall rate of stent-related perforation was 8.9%. The global recurrence rate was significantly higher in stent-related perforation group (41.2 vs. 30.8%; OR 1.70; 95%CI: 1.02–2.84; p = 0.04). Locoregional recurrence rate was higher in the perforated group than in the non-perforated group (26.6 vs. 12.5%), with statistically significant differences (OR 2.41; 95% CI:1.33–4.34; p = 0.004). No significant differences were found in systemic recurrence rate (13.6 vs. 20.5%; OR 0.77; 95%CI: 0.35–1.7; p = 0.51); 3-year overall survival rate (65.4 vs. 74.8%; OR 0.63; 95% CI:0.29–1.39; p = 0.25) and 5-year overall survival rate (48.3 vs. 58.6%; OR 0.67; 95%CI: 0.27–1.65; p = 0.38).

Conclusion

Stent-related perforation is associated with an increased risk of global and locoregional recurrence. The successful placement of the stent as a bridge to surgery in the curative purpose of patients with obstructed colon cancer does not exclude the presence of underlying perforation, with the consequent danger of disease spread.

PROSPERO registration number: CRD42020152817

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Data Availability

Yes

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Study conception design, data acquisition and data analysis and interpretation: Izaskun Balciscueta, Zutoia Balciscueta and Natalia Uribe.

Drafting the article and critical revision: Izaskun Balciscueta, Zutoia Balciscueta and Natalia Uribe.

Final approval of the manuscript: Izaskun Balciscueta, Zutoia Balciscueta, Natalia Uribe and Eduardo García-Granero.

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Correspondence to Izaskun Balciscueta.

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Balciscueta, I., Balciscueta, Z., Uribe, N. et al. Long-term outcomes of stent-related perforation in malignant colon obstruction: a systematic review and meta-analysis. Int J Colorectal Dis 35, 1439–1451 (2020). https://doi.org/10.1007/s00384-020-03664-1

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Keywords

  • Stent
  • Colon cancer
  • Surgery
  • Stent-related perforation
  • Colon obstruction