Introduction. Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT. Methods. We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries. Results. We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P=0.02), the stoma rate (28.8% versus 46.02%, P<0.0001), and the incidence of wound infection (8.11% versus 15.49%, P=0.01) were reduced after stent as a bridge to surgery. Conclusion. Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.

Allievi, N., Ceresoli, M., Fugazzola, P., Montori, G., Coccolini, F., & Ansaloni, L. (2017). Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis. INTERNATIONAL JOURNAL OF SURGICAL ONCOLOGY, 2017, 1-11 [10.1155/2017/2863272].

Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis

Ceresoli M.;Ansaloni L.
2017

Abstract

Introduction. Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT. Methods. We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries. Results. We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P=0.02), the stoma rate (28.8% versus 46.02%, P<0.0001), and the incidence of wound infection (8.11% versus 15.49%, P=0.01) were reduced after stent as a bridge to surgery. Conclusion. Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.
Articolo in rivista - Review Essay
Scientifica
SEMS; colonic obstruction
English
Allievi, N., Ceresoli, M., Fugazzola, P., Montori, G., Coccolini, F., & Ansaloni, L. (2017). Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis. INTERNATIONAL JOURNAL OF SURGICAL ONCOLOGY, 2017, 1-11 [10.1155/2017/2863272].
Allievi, N; Ceresoli, M; Fugazzola, P; Montori, G; Coccolini, F; Ansaloni, L
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/283978
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