Evidence map›Paper›PMID 27924392›Full record

Trial reportSurgical endoscopy2017

Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial).

Alberto Arezzo, Carmen Balague, Eduardo Targarona, Felice Borghi, Giorgio Giraudo, Luigi Ghezzo, Antonio Arroyo, Javier Sola-Vera, Paolo De Paolis, Maurizio Bossotti and 5 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Surgical endoscopy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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  7. Definition of large bowel obstruction by primary colorectal cancer: A systematic review.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2021
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26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Alberto ArezzoDepartment of Surgical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy. alberto.arezzo@unito.it.ORCID 0000-0002-2110-4082
Carmen BalagueHospital de la Sta Creu i St Pau, Barcelona, Spain.
Eduardo TargaronaHospital de la Sta Creu i St Pau, Barcelona, Spain.
Felice BorghiASO Santa Croce e Carle, Cuneo, Italy.
Giorgio GiraudoASO Santa Croce e Carle, Cuneo, Italy.
Luigi GhezzoASO Santa Croce e Carle, Cuneo, Italy.
Antonio ArroyoHospital General Universitario, Elche, Italy.
Javier Sola-VeraHospital General Universitario, Elche, Italy.
Paolo De PaolisHumanitas Gradenigo Hospital, Turin, Italy.
Maurizio BossottiHumanitas Gradenigo Hospital, Turin, Italy.
Elisa BannoneDepartment of Surgical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.
Edoardo ForcignanòDepartment of Surgical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.
Marco Augusto BoninoDepartment of Surgical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.
Roberto PasseraDivision of Nuclear Medicine, University of Torino, Turin, Italy.
Mario MorinoDepartment of Surgical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe aim of colonic stenting with self-expandable metallic stents in neoplastic colon obstruction is to avoid emergency surgery and thus potentially reduce morbidity, mortality, and need for a stoma. Concern has been raised, however, about the effect of colonic stenting on short-term complications and long-term survival. We compared morbidity rates after colonic stenting as a bridge to surgery (SBTS) versus emergency surgery (ES) in the management of left-sided malignant large-bowel obstruction.

methodsThis multicentre randomised controlled trial was designed with the endorsement of the European Association for Endoscopic Surgery. The study population was consecutive patients with acute, symptomatic malignant left-sided large-bowel obstruction localised between the splenic flexure and 15 cm from the anal margin. The primary outcome was overall morbidity within 60 days after surgery.

resultsBetween March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 29/144 (13.9%) were excluded post-randomisation mainly because of wrong diagnosis at computed tomography examination. The remaining 115 patients (SBTS n = 56, ES n = 59) were deemed eligible for analysis. The complications rate within 60 days was 51.8% in the SBTS group and 57.6% in the ES group (p = 0.529). Although long-term follow-up is still ongoing, no statistically significant difference in 3-year overall survival (p = 0.998) and progression-free survival rates between the groups has been observed (p = 0.893). Eleven patients in the SBTS group and 23 in the ES group received a stoma (p = 0.031), with a reversal rate of 30% so far.

conclusionsOur findings indicate that the two treatment strategies are equivalent. No difference in oncologic outcome was found at a median follow-up of 36 months. The significantly lower stoma rate noted in the SBTS group argues in favour of the SBTS procedure when performed in expert hands.

Indexed as

Self Expandable Metallic StentsAcute DiseaseAdultAgedAged, 80 and overColonColonic NeoplasmsDisease-Free SurvivalEmergenciesFemaleHumansIntestinal ObstructionMaleMiddle AgedBridge to surgeryEmergency colorectal surgeryEndoscopic stentingLarge bowel obstructionRandomized controlled trial

Identifiers

PMID27924392

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.