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Review
. 2025 Apr 1;9(4):632-642.
doi: 10.1002/ags3.70011. eCollection 2025 Jul.

Short-term and long-term outcomes of self-expandable metallic stent placement versus creation of a diverting stoma for obstructive colorectal cancer: A systematic review and meta-analysis

Thanakorn Yingruxpund  1   2 , Akihisa Matsuda  1 , Takeshi Yamada  1 , Chaiya Chansai  2 , Hiroshi Yoshida  1
Affiliations
Review

Short-term and long-term outcomes of self-expandable metallic stent placement versus creation of a diverting stoma for obstructive colorectal cancer: A systematic review and meta-analysis

Thanakorn Yingruxpund et al. Ann Gastroenterol Surg. .

Abstract

Aim: A diverting stoma (DS) is often used as a bridge to surgery in patients with obstructive colorectal cancer (OCRC). However, the self-expandable metallic stent (SEMS) has emerged as a less invasive option. This systematic review and meta-analysis compared the efficacy and safety of the SEMS with that of a DS for OCRC.

Methods: An electronic literature search through to May 2024 was performed to identify studies that compared the SEMS and DS as a bridge to surgery in patients with OCRC. The primary outcomes were postoperative complications and mortality. Secondary outcomes included clinical success of decompression, surgical site infection, anastomotic leakage, bleeding, permanent stoma creation, locoregional recurrence, and 3-year overall survival. The data were pooled using a random-effects model. The results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Five non-randomized studies that included 977 patients (SEMS, n = 427; DS, n = 550) were included. Postoperative complications (OR 0.78, 95% CI 0.60-1.01, p = 0.06) and mortality (OR 1.15, 95% CI 0.61-2.16, p = 0.67) were comparable between the groups. SEMS placement had a significantly lower clinical success of decompression but reduced the risk of surgical site infection (OR 0.45, 95% CI 0.27-0.77, p = 0.003). There was no significant between-group difference in frequency of anastomotic leakage (p = 0.68), bleeding (p = 0.94), permanent stoma formation (p = 0.95), locoregional recurrence (p = 0.31), or 3-year overall survival (p = 0.98).

Conclusion: Although clinical success was inferior to DS, SEMS contributed to comparable outcomes including postoperative complications, mortality, and long-term outcomes, but significantly reduced SSI. These findings support the broader adoption of SEMS in clinical practice, particularly requiring minimized invasiveness and improving patient quality of life are prioritized.

Keywords: bridge to surgery; diverting stoma; obstructive colorectal cancer; self‐expandable metallic stent.

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Conflict of interest statement

The authors declare no conflicts of interest for this article.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram summarizing the identification, screening, and inclusion of studies in the meta‐analysis. Five studies were included after screening of 258 records. CI, confidence interval; DS, diverting stoma; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses; SEMS, self‐expandable metallic stent.
FIGURE 2
FIGURE 2
Comparison of primary outcomes. Forest plot comparing (A) postoperative complications and (B) mortality between patients with obstructive colorectal cancer who underwent placement of a SEMS (self‐expandable metallic stent) and those in whom a DS (diverting stoma) was created.
FIGURE 3
FIGURE 3
Comparison of short‐term outcomes. Forest plot comparing (A) clinical succuss of decompression, (B) surgical site infections (SSI), (C) anastomotic leakage, (D) bleeding, and (E) need for a permanent stoma between the SEMS (self‐expandable metallic stent) group and the DS (diverting stoma) group.
FIGURE 4
FIGURE 4
Comparison of long‐term outcomes. Forest plot comparing (A) locoregional recurrence and (B) 3‐year overall survival between the SEMS (self‐expandable metallic stent) group and DS (diverting stoma) group.
See this image and copyright information in PMC

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