Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 26, 2017; 5(1): 1-13
Published online Feb 26, 2017. doi: 10.13105/wjma.v5.i1.1
Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: Meta-analysis with systematic review of the literature
Belinda De Simone, Fausto Catena, Federico Coccolini, Salomone Di Saverio, Massimo Sartelli, Arianna Heyer, Nicola De Angelis, Gian Luigi De Angelis, Luca Ansaloni
Belinda De Simone, Fausto Catena, Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
Federico Coccolini, Luca Ansaloni, Department of General and Emergency Surgery, Papa XXIII Hospital, 24121 Bergamo, Italy
Salomone Di Saverio, Department of General Surgery, Maggiore Hospital of Bologna, 42121 Bologna, Italy
Massimo Sartelli, Department of Emergency and General Surgery, Macerata’s Hospital, 62100 Macerata, Italy
Arianna Heyer, Department of Medical Sciences, University of California, Berkeley, CA 94720, United States
Nicola De Angelis, Liver Transplantation and General Surgery Unit, Henry Mondor Hospital, 94000 Creteil, France
Gian Luigi De Angelis, Department of Gastroenterology, University Hospital of Parma, 43100 Parma, Italy
Author contributions: De Simone B and Catena F designed the study; De Simone B collected the data and wrote the manuscript; De Simone B and Catena F statistically analyzed the data for meta-analysis; Catena F reviewed the manuscript; De Simone B revised the data and reviewed the final version of the manuscript; all the authors read and approved the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Belinda De Simone, Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 15, 43100 Parma, Italy. desimone.belinda@gmail.com
Telephone: +39-32-00771984 Fax: +39-05-21702134
Received: July 21, 2016
Peer-review started: July 25, 2016
First decision: September 29, 2016
Revised: October 15, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: February 26, 2017
Processing time: 220 Days and 11.5 Hours
Abstract
AIM

To investigate by meta-analytic study and systematic review, advantages of colonic stent placement in comparison with emergency surgery.

METHODS

We conducted an extensive literature search by PubMed, Google Scholar, Embase and the Cochrane Libraries. We searched for all the papers in English published till February 2016, by applying combinations of the following terms: Obstructive colon cancer, colon cancer in emergency, colorectal stenting, emergency surgery for colorectal cancer, guidelines for obstructive colorectal cancer, stenting vs emergency surgery in the treatment of obstructive colorectal cancer, self-expanding metallic stents, stenting as bridge to surgery. The study was designed following the Prisma Statement. By our search, we identified 452 studies, and 57 potentially relevant studies in full-text were reviewed by 2 investigators; ultimately, 9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic review.

RESULTS

In the meta-analysis, by comparing colonic stenting (CS) as bridge to surgery and emergency surgery, the pooled analysis showed no significant difference between the two techniques in terms of mortality [odds ratio (OR) = 0.91], morbidity (OR = 2.38) or permanent stoma rate (OR = 1.67); primary anastomosis was more frequent in the stent group (OR = 0.45; P = 0.004) and stoma creation was more frequent in the emergency surgery group (OR = 2.36; P = 0.002). No statistical difference was found in disease-free survival and overall survival. The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups (OR = 0.37), with a significantly higher 1-year recurrence rate in the stent group (P = 0.007).

CONCLUSION

CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.

Keywords: Colonic stent; Self-expandable metallic stent; Obstructive left colon cancer; Emergency surgery; Endo-laparoscopic approach; Oncological outcome

Core tip: The management of patients presenting with acute large bowel obstruction caused by left-sided colorectal cancer is still debated. Recently published conflicting results regarding colonic stenting and its oncological outcome, not allowing the emergency surgeon to consider this therapeutic option, with the aim to convert an urgent situation into an elective one and to decrease the stoma creation rate. We decided to carry out a meta-analysis of all the available randomized controlled trials comparing colonic stenting vs surgical decompression to investigate the real advantage of self-expandable metallic stent placement and its oncological safety.