Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials

Background and Aims Twenty years after the first description of the technique, the debate is still open on the role of self-expandable metallic stent (SEMS) placement as a bridge to elective surgery for symptomatic left-sided malignant colonic obstruction. The aim was to compare morbidity rates afte...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2017-09, Vol.86 (3), p.416-426
Main Authors: Arezzo, Alberto, MD, Passera, Roberto, PhD, Lo Secco, Giacomo, MD, Verra, Mauro, MD, Bonino, Marco Augusto, MD, Targarona, Eduardo, MD, Morino, Mario, MD
Format: Article
Language:English
Subjects:
Colectomy - methods
Colon, Descending - surgery
Colonic Neoplasms - complications
Colonic Neoplasms - surgery
Colostomy - statistics & numerical data
Elective Surgical Procedures
Emergencies
Gastroenterology and Hepatology
Humans
Intestinal Obstruction - etiology
Intestinal Obstruction - surgery
Postoperative Complications - epidemiology
Randomized Controlled Trials as Topic
Self Expandable Metallic Stents
Surgical Stomas
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Summary:Background and Aims Twenty years after the first description of the technique, the debate is still open on the role of self-expandable metallic stent (SEMS) placement as a bridge to elective surgery for symptomatic left-sided malignant colonic obstruction. The aim was to compare morbidity rates after colonic stenting bridge to surgery (SBTS) versus emergency surgery (ES) for left-sided malignant obstruction. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) on SBTS or ES for acute symptomatic malignant left-sided large bowel obstruction. The primary outcome was overall morbidity within 60 days after surgery. Results The meta-analysis included 8 RCTs and 497 patients. Overall mortality within 60 days after surgery was 9.6% in SBTS-treated patients and 9.9% in ES-treated patients (relative risk [RR], 0.99; P  = .97). Overall morbidity within 60 days after surgery was 33.9% in SBTS-treated patients and 51.2% in ES-treated patients (RR, 0.59; P  = .023). The temporary stoma rate was 33.9% after SBTS and 51.4% after ES (RR, 0.67; P  
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2017.03.1542