Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2012; 18(39): 5608-5615
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5608
Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: A systematic review and meta-analysis
Guang-Yao Ye, Zhe Cui, Lu Chen, Ming Zhong
Guang-Yao Ye, Zhe Cui, Lu Chen, Ming Zhong, Department of General Surgery, Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Author contributions: Ye GY, Cui Z and Chen L designed the study, collected and analyzed the data and wrote the manuscript; Zhong M analyzed the data and contributed to the discussion; Ye GY and Cui Z independently assessed the titles and abstracts of all identified citations; Chen L resolved the disagreement; Ye GY and Cui Z evaluated the full text of all potentially eligible papers and decided whether to include or exclude each study according to the inclusion and exclusion criteria.
Correspondence to: Lu Chen, Professor, MD, Department of General Surgery, Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China. chenlu_65@163.com
Telephone: +86-21-53882032 Fax: +86-21-63261383
Received: January 21, 2012
Revised: March 19, 2012
Accepted: May 5, 2012
Published online: October 21, 2012
Abstract

AIM: To investigate the effects of emergent preoperative self-expandable metallic stent (SEMS) vs emergent surgery for acute left-sided malignant colonic obstruction.

METHODS: Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated.

RESULTS: Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI: 0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI: 0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI: 0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI: 0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI: 0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13).

CONCLUSION: SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.

Keywords: Acute obstruction, Colonic cancer, Self-expandable metallic stent, Stoma placement, Meta-analysis, Systematic review