Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;103(4):235-244.
doi: 10.1308/rcsann.2020.7137. Epub 2021 Mar 8.

Diversion, resection, or stenting as a bridge to surgery for acute neoplastic left-sided colonic obstruction: a systematic review and network meta-analysis of studies with curative intent

P Gavriilidis  1 , N de'Angelis  2 , J Wheeler  3 , A Askari  4 , S Di Saverio  5 , J R Davies  3
Affiliations

Diversion, resection, or stenting as a bridge to surgery for acute neoplastic left-sided colonic obstruction: a systematic review and network meta-analysis of studies with curative intent

P Gavriilidis et al. Ann R Coll Surg Engl. 2021 Apr.

Abstract

Introduction: The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction.

Methods: A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed. A traditional meta-analysis and subsequent NMA were conducted.

Findings: A significantly greater number of primary anastomoses were performed in the DC cohort than in the EC and SBTS cohorts. The 90-day mortality rate was significantly lower in the DC cohort than in the EC and SBTS cohorts. Higher costs were associated with the SBTS cohort (by US$2,000) than with the EC cohort. The locoregional recurrence rate was higher for the SBTS cohort than for the EC cohort.

Conclusions: Evidence from the first NMA suggests there may be some clinical advantages associated with DC as an alternative approach to the EC and SBTS approaches for adequately selected patients with malignant large bowel obstruction.

Keywords: Acute colectomy; Acute resection; Colonic obstruction; Diversion; Endoluminal stenting.

PubMed Disclaimer

Conflict of interest statement

All named authors hereby declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Diagram of search strategy
Figure 2
Figure 2
Forest plots of NMA age, permanent stoma, primary resection anastomosis, mortality. CrI = credible interval.
Figure 3
Figure 3
NMA league table comparing all three treatment modalities in terms of outcomes. CI = confidence interval; DC = decompressing colostomy; EC = emergency colectomy; NMA = network meta-analysis; OR = odds ratio; SBTS = stenting as a bridge to surgery.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192: 719–725.10.1016/S1072-7515(01)00833-X - DOI - PubMed
    1. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol; 2004; 13: 149–157.10.1016/j.suronc.2004.08.002 - DOI - PubMed
    1. Meyer F, Marusch F, Koch Aet al. . Emergency operation in carcinomas of the left colon: value of Hartmann’s procedure. Tech Coloproctol 2004; 8(Suppl 1): s226–s229.10.1007/s10151-004-0164-3 - DOI - PubMed
    1. van Ommeren-Olijve SJ, Burbach JPM, Furnée EJB, Dutch Snapshot Research Group. Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer. Int J Colorectal Dis 2020; 35: 1087–1093.10.1007/s00384-020-03559-1 - DOI - PMC - PubMed
    1. van Hooft JE, Bemelman WA, Oldenburg Bet al. . Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12: 344–352.10.1016/S1470-2045(11)70035-3 - DOI - PubMed

Publication types