Large Japanese Real-World Experience Suggests Self-Expandable Metal Stents Are Beneficial in Obstructive Colorectal Cancer
Douglas K. Rex, MD, MASGE, reviewing Moroi R, et al. J Gastroenterol Hepatol 2022 Apr 17.
Randomized controlled trials (RCT) of emergency surgery versus colonic stent placement using self-expandable metal stents (SEMS) have mostly suggested limited or no benefits from SEMS.
This study utilized a nationwide Japanese database of patients with obstructive colorectal cancer urgently admitted to the hospital and treated with SEMS versus surgery. Researchers performed propensity score matching for sex, age, body mass index, comorbidities, smoking history, hospital type, TNM classification, and disease location.
Among 17,368 eligible cases, 9525 were assigned to SEMS and 7843 to surgery, with 6804 pairs of patients after propensity score matching.
In matched analysis, the in-hospital death rate decreased with SEMS versus surgery (2.0% vs 3.3%; P<.0001). With SEMS, hospitalization duration was shorter at 16 versus 24 days and medical costs were cut by about one-third.
COMMENTAlthough this study design has limitations compared to randomized trials, the systematic nature of the database and the high number of patients provide the opportunity to see differences that might not be as evident in an RCT on a smaller number of patients.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Moroi R, Tarasawa K, Shimoyama Y, et al. Effectiveness of colonic stent placement for obstructive colorectal cancers: an analysis of short-term results using a nationwide database in Japan. J Gastroenterol Hepatol 2022 Apr 17. (Epub ahead of print) (https://doi.org/10.1111/jgh.15857)
