Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta-analysis
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Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta‑analysis S. R. Jain1 · C. Y. L. Yaow1 · C. H. Ng1 · V. S. Q. Neo1 · F. Lim2 · F. J. Foo3 · N. W. Wong2 · C. S. Chong1,2 Received: 6 May 2020 / Accepted: 5 July 2020 © Springer Nature Switzerland AG 2020
Abstract Background Emergency surgery (ES) is the standard-of-care for left-sided obstructing colon cancer, with self-expanding metallic stents (SEMSs) and diverting colostomies (DCs) being alternative approaches. The aim of this study was to review the short- and long-term outcomes of SEMS versus ES or DC. Methods Embase and Medline were searched for articles comparing SEMS versus ES or DC. Primary outcomes were survival and recurrence rates. Secondary outcomes were peri- and postoperative outcomes. SEMS-specific outcomes include success and complication rates. Pooled odds ratio and 95% confidence interval were estimated with DerSimonian and Laird random effects used to account for heterogeneity. Results Thirty-three studies were included, involving 15,224 patients in 8 randomized controlled trials and 25 observational studies. There were high technical and clinical success rates for SEMS, with low rates of complications. Our meta-analysis revealed increased odds of laparoscopic surgery and anastomosis, and decreased stoma creation with SEMS compared to ES. SEMS led to fewer complications, including anastomotic leak, wound infection, ileus, myocardial infarction, and improved 90-day in-hospital mortality. There were no significant differences in 3- and 5-year overall, cancer-specific and disease-free survival. SEMS, compared to DC, led to decreased rates of stoma creation, higher rates of ileus and reoperation, and led to longer hospital stay. Conclusions SEMS leads to better short-term outcomes but confers no survival advantage over ES. It is unclear whether SEMS has better short-term outcomes compared to DC. There is a lack of randomized trials with long-term outcomes for SEMS versus DC, hence results should be interpreted with caution. Keywords Self-expandable metallic stent · Emergency surgery · Surgical stomas · Meta-analysis
Introduction S. R. Jain and C. Y. L. Yaow made an equal contribution. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02296-5) contains supplementary material, which is available to authorized users. * C. S. Chong [email protected] 1
Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
2
Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
3
Department of General Surgery, Sengkang Health, Singapore, Singapore
International guidelines recommend emergency surgery (ES) for treatment of left obstructive colon cancer (LOCC) [1, 2], but ES is a risk factor for high morbidity and mortality [3–5]. Initial bowel decompression, via self-expanding metallic stents
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