Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and
- PDF / 1,178,764 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 54 Downloads / 185 Views
REVIEW
Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta‑analysis I. Balciscueta1 · Z. Balciscueta2 · N. Uribe2 · E. García‑Granero1 Received: 17 June 2020 / Accepted: 23 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background In recent years, there has been growing concern about the potential association of stent placement as a bridge to surgery in malignant colon obstruction and some anatomopathological findings that could lead to worsening long-term cancer outcomes, such as perineural, vascular and lymphatic invasion. The aim of the present review was to assess the pathological changes found in surgical specimens after stent placement for obstructing colon cancer vs. emergency surgery, and the impact of perineural invasion on survival rates Methods MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed four meta-analyses to estimate the pooled effect sizes using a random effect model. The outcomes were perineural, vascular and lymphatic invasion rates, and 5-year overall survival rate in patients with obstructive colon cancer, depending on the presence or absence of perineural invasion. Results Ten studies with a total of 1273 patients were included in the meta-analysis. We found that patients in the stent group had a significantly higher risk of perineural (OR 1.98, 95% CI 1.22–3.21; p = 0.006) and lymphatic invasion (OR 1.45, 95% CI 1.10–1.90; p = 0.008). Furthermore, patients with positive perineural invasion had almost twice the risk of dying compared to those with no perineural invasion (HR 1.92, 95% CI 1.22–3.02; p = 0.005). Conclusions Stent placement as a bridge to surgery in colorectal cancer patients modifies the pathological characteristics such as perineural and lymphatic invasion, and this may worsen the long-term prognosis of patients. The presence of perineural infiltration in obstructed colon cancer decreases the long-term survival of patients. Keywords Stents · Colonic neoplasms · Intestinal obstruction · Prognosis · Perineural invasion · Lymphovascular invasion · Survival rate I. Balciscueta and Z. Balciscueta contributed equally to this article.
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02350-2) contains supplementary material, which is available to authorized users.
Recent meta-analyses [1–3] have stated that both perineural invasion (PNI) and lymphovascular invasion (LVI) negatively affect the long-term prognosis of patients with colorectal cancer (CRC). The presence of these pathological findings in surgical specimens, even in patients without nodal involvement, have proven to be strong stage-independent prognostic markers [4–6] and their presence is considered to be an indicator of poor outcome and an augury of lower overall and disease-free survival rates [1–3]. Obstruction itself is a factor independently associated with PNI in colon cancer, probably due t
Data Loading...
