endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis
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2017
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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.
| Reference Key |
allievi2017internationalendoscopic
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| Authors | ;Niccolò Allievi;Marco Ceresoli;Paola Fugazzola;Giulia Montori;Federico Coccolini;Luca Ansaloni |
| Journal | Langmuir : the ACS journal of surfaces and colloids |
| Year | 2017 |
| DOI |
10.1155/2017/2863272
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