Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

• Published in: Surgery today (Tokyo, Japan) Japan), 2019-09, Vol.49 (9), p.728-737
• Main Authors: Matsuda, Akihisa, Yamada, Takeshi, Matsumoto, Satoshi, Sakurazawa, Nobuyuki, Kawano, Youichi, Sekiguchi, Kumiko, Matsutani, Takeshi, Miyashita, Masao, Yoshida, Hiroshi
• Format: Article
• Language: English
• Subjects: Aged; Colorectal Neoplasms - complications; Databases, Bibliographic; Decompression, Surgical - methods; Eating; Female; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intestine, Large; Male; Medicine; Medicine & Public Health; Middle Aged; Quality of Life; Review Article; Self Expandable Metallic Stents; Surgery; Surgical Oncology; Time Factors; Treatment Outcome
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-019-01784-y

Purpose Preoperative intestinal decompression, using either a self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) or a transanal decompression tube (TDT), provides an alternative to emergency surgery for malignant large-bowel obstruction (MLBO). We conducted this meta-analysis to compare the short-term outcomes of SEMS placement as a BTS vs. TDT placement for MLBO. Methods We conducted a comprehensive electronic search of literature published up to March, 2018, to identify studies comparing the short-term outcomes of BTS vs. TDT. Decompression device-related and surgery-related variables were evaluated and a meta-analysis was performed using random-effects models to calculate odd ratios with 95% confidence intervals. Results We analyzed 14 nonrandomized studies with a collective total of 581 patients: 307 (52.8%) who underwent SEMS placement as a BTS and 274 (47.2%) who underwent TDT placement. The meta-analyses showed that the BTS strategy conferred significantly better technical and clinical success, helped to maintain quality of life by allowing free food intake and temporal discharge, promoted laparoscopic one-stage surgery without stoma creation, and had equivalent morbidity and mortality to TDT placement. Conclusions Although the long-term outcomes are as yet undetermined, the BTS strategy using SEMS placement could be a new standard of care for preoperative decompression to manage MLBO.