M62 Course April 7-8 2005 SURGERY for COLONIC CROHN’S DISEASE RJ NICHOLLS.
Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for...
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Transcript of Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for...
Dr Arjun Rajagopalan
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?
Dr Arjun Rajagopalan
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
Dr Arjun Rajagopalan
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
Dr Arjun Rajagopalan
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 -