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Meta-Analysis
. 2024 Oct;38(10):5514-5527.
doi: 10.1007/s00464-024-11187-x. Epub 2024 Aug 29.

Short-term and three-year long-term outcomes of laparoscopic surgery versus open surgery for obstructive colorectal cancer following self-expandable metallic stent placement: a meta-analysis

Shintaro Kanaka  1 , Takeshi Yamada  2 , Akihisa Matsuda  2 , Kay Uehara  2 , Seiichi Shinji  2 , Yasuyuki Yokoyama  2 , Goro Takahashi  2 , Takuma Iwai  2 , Kohki Takeda  2 , Sho Kuriyama  2 , Toshimitsu Miyasaka  2 , Hiroshi Yoshida  2
Affiliations
Meta-Analysis

Short-term and three-year long-term outcomes of laparoscopic surgery versus open surgery for obstructive colorectal cancer following self-expandable metallic stent placement: a meta-analysis

Shintaro Kanaka et al. Surg Endosc. 2024 Oct.

Abstract

Background: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer.

Methods: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

Results: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32-0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50-1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41-1.12, P = 0.13).

Conclusion: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer.

Keywords: Cancer; Colon; Laparoscopic; Obstruction; Self-expandable metallic stent; Surgery.

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Figures

Fig. 1
Fig. 1
Flowchart showing the study selection process according to the PRISMA guidelines
Fig. 2
Fig. 2
Meta-analysis of postoperative complication rates using a fixed-effect Mantel–Haenszel model. Odds ratios are shown with 95% CIs. CI confidence interval, LS laparoscopic surgery, OpS open surgery
Fig. 3
Fig. 3
Meta-analysis of postoperative mortality rates using a fixed-effect Mantel–Haenszel model. Odds ratios are shown with 95% confidence intervals. CI confidence interval, LS laparoscopic surgery, OpS open surgery
Fig. 4
Fig. 4
Meta-analysis of 3-year recurrence-free survival using a fixed-effect Mantel–Haenszel model. Odds ratios are shown with 95% confidence intervals. CI confidence interval, LS laparoscopic surgery, OpS open surgery
Fig. 5
Fig. 5
Meta-analysis of 3-year overall survival using a fixed-effect Mantel–Haenszel model. Odds ratios are shown with 95% confidence intervals. CI confidence interval, LS laparoscopic surgery, OpS open surgery
See this image and copyright information in PMC

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