Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials
Despite 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.
The aim of this meta-analysis was to evaluate whether BTS stent is a safe alternative to emergency surgery (EmS).
Randomized 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.
There 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.
BTS 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.
KeywordsColon obstruction Bridge to surgery Stent Colorectal cancer SEMS
The authors thank Dr. Karen Tung, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China for providing the additional information regarding the long-term results of the study conducted in her center.
Compliance with ethical standards
Drs. Chi Chung Foo, Samuel Ho Ting Poon, Rosemaire Hon Yiu Chiu, Wai Yiu Lam, and Lam Chi Cheung and Professor Wai Lun Law have no conflicts of interest or financial ties to disclose.
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