Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials

被引:71
|
作者
Foo, Chi Chung [1 ]
Poon, Samuel Ho Ting [2 ]
Chiu, Rosemaire Hon Yiu [2 ]
Lam, Wai Yiu [2 ]
Cheung, Lam Chi [2 ]
Law, Wai Lun [1 ]
机构
[1] Univ Hong Kong, Queen Mary Hosp, Dept Surg, 102 Pokfulam Rd, Hong Kong, Peoples R China
[2] Univ Hong Kong, Li Ka Shing Fac Med, Hong Kong, Peoples R China
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2019年 / 33卷 / 01期
关键词
Colon obstruction; Bridge to surgery; Stent; Colorectal cancer; SEMS; EXPANDING METALLIC STENTS; SIDED COLORECTAL-CANCER; CONVENTIONAL OPEN SURGERY; LAPAROSCOPIC APPROACH; ELECTIVE SURGERY; MULTICENTER; MANAGEMENT; RESECTION; EFFICACY; CARCINOMA;
D O I
10.1007/s00464-018-6487-3
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundDespite studies showing superior results in terms of reduced stoma rate and higher primary anastomosis rate, the safety of bridge to surgery stenting (BTS stent) for left-sided malignant colonic obstruction, especially in oncological terms, remains a concern.AimThe aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).MethodsRandomized control trials (RCTs) comparing BTS stent and EmS for left-sided colonic obstruction caused by primary cancer of the colon, up to Sep 2018, were retrieved from the Pubmed, Embase database, clinical trials registry of U. S. National Library of Medicine and BMJ and Google Search.ResultsThere were seven eligible RCTs, involving a total of 448 patients. Compared to EmS, BTS stent had a significantly lower risk of overall complications (RR=0.605; 95% CI 0.382-0.958; p=0.032). However, the overall recurrence rate was higher in the BTS stent group (37.0% vs. 25.9%; RR=1.425; 95% CI 1.002-2.028; p=0.049). BTS stent significantly increased the risk of systemic recurrence (RR=1.627; 95% CI 1.009-2.621; p=0.046). This did not translate into a significant difference in terms of 3-year disease-free survival or 3-year overall survival.ConclusionBTS stent is associated with a lower rate of overall morbidities than EmS. However, BTS stent was associated with a greater chance of recurrence, especially systemic recurrence. Clinicians ought to be aware of the pros and cons of different interventions and tailor treatments for patients suffering from left-sided obstructing cancer of the colon.
引用
收藏
页码:293 / 302
页数:10
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