Original Article

International Journal of Colorectal Disease

, Volume 28, Issue 6, pp 855-863

First online:

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

  • Vincenzo CennamoAffiliated withUnit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital Email author 
  • , Carmelo LuigianoAffiliated withUnit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi
  • , Federico CoccoliniAffiliated withUnit of General Surgery, Ospedali Riuniti
  • , Carlo FabbriAffiliated withUnit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital
  • , Marco BassiAffiliated withUnit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital
  • , Giuseppe De CaroAffiliated withUnit of Gastroenterology and Digestive Endoscopy, AO Treviglio-Caravaggio
  • , Liza CeroniAffiliated withUnit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital
  • , Antonella MaimoneAffiliated withUnit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital
  • , Paolo RavelliAffiliated withUnit of Gastroenterology, Ospedali Riuniti
    • , Luca AnsaloniAffiliated withUnit of General Surgery, Ospedali Riuniti

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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 obstruction Meta-analysis Self-expandable metal stent Bridge to surgery Emergency surgery