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

International Journal of Colorectal Disease volume 28, pages 855–863 (2013)Cite this article

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.

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Conflict of interest

Neither this submitted paper nor any similar paper, in whole or in part, has been or will be submitted to any other primary scientific journal. All authors reviewed this manuscript and agreed with the contents. There are no financial arrangements or commercial associations (e.g., equity ownership or interest, consultancy, patent and licensing agreement, or institutional and corporate associations) that might be a conflict of interest in relation to the submitted manuscript.

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Affiliations

  1. Unit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital, Via Altura, 40139, Bologna, Italy

    Vincenzo Cennamo, Carlo Fabbri, Marco Bassi, Liza Ceroni & Antonella Maimone

  2. Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy

    Carmelo Luigiano

  3. Unit of Gastroenterology and Digestive Endoscopy, AO Treviglio-Caravaggio, Treviglio, Italy

    Giuseppe De Caro

  4. Unit of Gastroenterology, Ospedali Riuniti, Bergamo, Italy

    Paolo Ravelli

  5. Unit of General Surgery, Ospedali Riuniti, Bergamo, Italy

    Federico Coccolini & Luca Ansaloni

Authors
  1. Vincenzo Cennamo
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  2. Carmelo Luigiano
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  3. Federico Coccolini
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  4. Carlo Fabbri
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  5. Marco Bassi
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  6. Giuseppe De Caro
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  7. Liza Ceroni
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  8. Antonella Maimone
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  9. Paolo Ravelli
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  10. Luca Ansaloni
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Correspondence to Vincenzo Cennamo.

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Cennamo, V., Luigiano, C., Coccolini, F. et al. Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction. Int J Colorectal Dis 28, 855–863 (2013). https://doi.org/10.1007/s00384-012-1599-z

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  • DOI: https://doi.org/10.1007/s00384-012-1599-z

Keywords

  • Acute colorectal cancer obstruction
  • Meta-analysis
  • Self-expandable metal stent
  • Bridge to surgery
  • Emergency surgery