International Journal of Colorectal Disease

, Volume 28, Issue 6, pp 855–863

Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction

Authors

    • Unit of Digestive Endoscopy, Department of SurgeryAUSL Bologna Bellaria Hospital
  • Carmelo Luigiano
    • Unit of Gastroenterology and Digestive EndoscopyARNAS Garibaldi
  • Federico Coccolini
    • Unit of General SurgeryOspedali Riuniti
  • Carlo Fabbri
    • Unit of Digestive Endoscopy, Department of SurgeryAUSL Bologna Bellaria Hospital
  • Marco Bassi
    • Unit of Digestive Endoscopy, Department of SurgeryAUSL Bologna Bellaria Hospital
  • Giuseppe De Caro
    • Unit of Gastroenterology and Digestive EndoscopyAO Treviglio-Caravaggio
  • Liza Ceroni
    • Unit of Digestive Endoscopy, Department of SurgeryAUSL Bologna Bellaria Hospital
  • Antonella Maimone
    • Unit of Digestive Endoscopy, Department of SurgeryAUSL Bologna Bellaria Hospital
  • Paolo Ravelli
    • Unit of GastroenterologyOspedali Riuniti
  • Luca Ansaloni
    • Unit of General SurgeryOspedali Riuniti
Original Article

DOI: 10.1007/s00384-012-1599-z

Cite this article as:
Cennamo, V., Luigiano, C., Coccolini, F. et al. Int J Colorectal Dis (2013) 28: 855. doi:10.1007/s00384-012-1599-z

Abstract

Purpose

Surgical decompression is the traditional treatment for acute colorectal cancer obstruction. In recent years, colorectal stenting has been used to relieve the obstruction. This study used meta-analytic techniques to compare colonic stenting versus surgical decompression for colorectal cancer obstruction.

Methods

A comprehensive search of several databases was conducted. The search identified 321 potential abstracts and titles of which eight randomized trials involving 353 patients were retrieved in full text. A meta-analysis of the studies included was carried out to identify the differences in outcomes between the two procedures.

Results

The pooled analysis showed no significant differences for mortality (odds ratio (OR) 0.91) and morbidity (OR 2.05) rates between the two strategies while the permanent stoma creation rate was significantly higher in the surgical group as compared to the stent group (OR 3.12). By comparing surgery and colonic stenting in studies which analyzed the use of stenting as a “bridge to surgery,” the pooled analysis showed that primary anastomosis was more frequent in the stent group as compared to the surgical group (OR 0.42), and the stoma creation was more frequent in the surgical group as compared to the stent group (OR 2.36).

Conclusion

Our study suggested that, in patients with acute colorectal cancer obstruction, stent placement improved several outcomes, such as primary anastomosis, stoma formation, and permanent stoma, while it failed to show an improvement in mortality and morbidity risk.

Keywords

Acute colorectal cancer obstructionMeta-analysisSelf-expandable metal stentBridge to surgeryEmergency surgery

Copyright information

© Springer-Verlag Berlin Heidelberg 2012