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Meta-Analysis
. 2017:2017:2863272.
doi: 10.1155/2017/2863272. Epub 2017 Jul 5.

Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis

Niccolò Allievi  1 , Marco Ceresoli  1 , Paola Fugazzola  1 , Giulia Montori  1 , Federico Coccolini  1 , Luca Ansaloni  1
Affiliations
Meta-Analysis

Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis

Niccolò Allievi et al. Int J Surg Oncol. 2017.

Abstract

Introduction: Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT.

Methods: We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries.

Results: We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P = 0.02), the stoma rate (28.8% versus 46.02%, P < 0.0001), and the incidence of wound infection (8.11% versus 15.49%, P = 0.01) were reduced after stent as a bridge to surgery.

Conclusion: Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.

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Figures

Figure 1
Figure 1
Flow chart of study selection according to PRISMA guidelines.
Figure 2
Figure 2
Meta-analysis of mortality rates using fixed-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 3
Figure 3
Meta-analysis of postoperative complication rates using random-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 4
Figure 4
Meta-analysis of primary anastomosis rates using random-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 5
Figure 5
Meta-analysis of successful primary anastomosis rates using random-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 6
Figure 6
Meta-analysis of stoma rates using fixed-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 7
Figure 7
Meta-analysis of stoma rates at latest follow-up using fixed-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 8
Figure 8
Meta-analysis of anastomotic leak rates using fixed-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
Figure 9
Figure 9
Meta-analysis of infectious complication rates using fixed-effect Mantel-Haenszel models. Risk ratio shown with 95% confidence intervals. ES: emergency surgery; SBTS: stent as a bridge to surgery.
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