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Large Bowel Obstruction

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Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients
Mege D, Manceau G, Beyer-Berjot L, Bridoux V, Lakkis Z, Venara A, Voron T, Brunetti F, Sielezneff I, Karoui M; AFC (French Surgical Association) Working Group.
Eur J Surg Oncol. 2018 Oct;44(10):1522-1531.

Rationale for inclusion: This retrospective cohort study found that a majority of patients with obstructing right-sided colon cancer can be managed with resection and primary anastomosis but high-risk patients may benefit from a staged surgical approach.

CAVEAT: Retrospective national cohort study.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial).
Arezzo A1, Balague C2, Targarona E2, Borghi F3, Giraudo G3, Ghezzo L3, Arroyo A4, Sola-Vera J4, De Paolis P5, Bossotti M5, Bannone E6, Forcignanò E6, Bonino MA6, Passera R7, Morino M6.
Surg Endosc. 2017 Aug;31(8):3297-3305.

Rationale for inclusion: Multicenter study comparing self-expandable metallic stents as a bridge to surgery versus emergency surgery found no difference in morbidity and oncologic outcome at 36 months but there was a lower stoma rate in the stent group. A “non-inferiority” RCT with survival as primary end point would be the appropriate method to correctly investigate long-term outcomes after SEMS as BTS versus ES.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Colorectal stents for the management of malignant colonic obstructions
Sagar J.
Cochrane Database Syst Rev. 2011 Nov 9;(11):CD007378.

Rationale for inclusion: This Cochrane Review including 5 randomized trials concluded that colonic stents for malignant colorectal obstruction are safe but have no advantage over emergency surgery in terms of clinical success rate.

CAVEAT: Systematic review limited by variability in sample size and trial design.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial.
van Hooft JE1, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P; collaborative Dutch Stent-In study group.
Lancet Oncol. 2011 Apr;12(4):344-52

Rationale for inclusion: One of the few multicenter randomized trials comparing stenting and emergency surgery for malignant large bowel obstruction. The authors concluded that colonic stenting has no decisive clinical advantages to emergency surgery but could be used as an alternative treatment in as yet undefined subsets of patients, although with caution because of concerns about tumor spread caused by perforation.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial.
Cheung HY1, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK.
Arch Surg. 2009 Dec;144(12):1127-32.

Rationale for inclusion: Despite being a smaller study, this RCT found that self-expanding metal stents are a safe and effective bridge to subsequent laparoscopic surgery in patients with obstructing left-sided colon cancer.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases.
Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, Onbas O.
Dis Colon Rectum. 2007 Apr;50(4):489-97.

Rationale for inclusion: This is one of the larger retrospective reviews pertaining to the management of sigmoid volvulus. The study advocates for the surgical management of this condition.

CAVEAT: Retrospective review.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation.
Evans RO, Thampi KA, Mukherjee K, Stephenson BM.
Br J Surg. 1996 Apr;83(4):572.

Rationale for inclusion: First prospective RCT to compare subtotal colectomy with segmental resection and anastomosis after intraoperative irrigation for malignant left sided colonic obstruction. The authors found no differences in terms of morbidity and mortality, but significantly worse functional results after TC.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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