Meta-analysis Of Obstruction Catheter And Stent For Colorectal Cancer Patients Complicated With Intestinal Obstruction

Background and Objective: Obstructive colorectal cancer is one of the most common acute abdominal diseases in gastrointestinal surgery.At this time,the local intestinal edema and expansion are obvious,and the patient’s general condition is not good.Emergency surgery with obstruction has a higher mortality rate.There were still more complications in the perioperative period even if one stage of fistula was performed and the second stage of tumor resection was performed.Therefore,effective preoperative management measures should be taken to improve the patients’ general state,to change emergency operation to elective operation,and to switch to open operation as far as possible to laparoscopic radical resection of colorectal cancer and to ensure the safety of the operation.In recent years,Transanal drainage tube and endovascular stents have been widely used in the treatment of obstructive colorectal cancer.At present,transanal drainage catheter and Self-Expandable-Metal-Stent can be used as a bridge from emergency operation to elective operation,which can improve the clinical conditions of patients and reduce the mortality,fistula rate and postoperative complications.However,there are still many controversies about which effect is better.There are obvious differences in research quality,research methods and research results,and the evidence of evidence-based medicine is not enough.Therefore,based on the existing control studies,this study conducted a Meta analysis to evaluate the convenience,economy and effectiveness of preoperative placement of tube and stent for the treatment of obstructive colorectal cancer.It is hoped to provide reference for the clinical treatment of obstructive colorectal cancer.Methods: Pub Med,EMBASE,FMRS,the Cochrane Library,VIP database,Wanfang database,CNKI and other major databases at home and abroad as well as literature tracking methods were searched to get published on preoperative placed transanal drainage tube and Self-Expandable-Metal-Stent in the treatment of obstructive colorectal cancer randomised controlled trial research,retrieval time limit for a Library to December 2020.Inclusion criteria and exclusion criteria were strictly formulated by two researchers.After screening the literature,the final relevant study was included and the quality of the included study was evaluated by the modified Jadad scale.A data table was developed for inclusion in the study,and the data were extracted independently by two researchers.The Rev Man 5.3 software was used for Meta analysis of the data in each study,and the mean difference(MDs),odds ratio(ORs)and 95% confidence interval(CIs)were calculated.Sensitivity analysis was conducted after one by one exclusion of the included literature,and Begg ’s test was performed by STATA14.0 to analyze the inter-study publication bias.Results: 144 related literatures were retrieved by subject words and free words combined with other methods.According to the inclusion criteria,the titles,abstracts and full text of the articles were read in detail,and 17 randomized controlled studies were finally included,including a total of 1136 patients,including 566 patients in the transanal drainage tube group and 570 patients in the Self-Expandable-Metal-Stent group.Placement time,expenditure in the transanal drainage tube were better than thosein the stent group,with statistically significant differences(MD=-24.88,95%CI:-26.58~ 23.18,P<0.000 01),(MD=-10.06,95%CI:-11.42~-8.70,P<0.000 01).The success rate of transanal drainage tube placement was higher than those in the stent group(OR=4.54,95%CI: 1.81~11.40,P< 0.001),and the relief time of abdominal pain and abdominal distension was slower in the stent group with statistically significant differences(MD=5.42,95%CI: 2.78~8.05,P<0.000 1).In the transanal drainage tube group,the intestinal preparation time from placement to preoperation(MD=1.42,95%CI: 0.21-2.63,P= 0.02)and the length of staying in hospital was longer in the stent group(MD=1.16,95%CI: 0.38-1.94,P=0.003).There was no statistically significant difference in the reduction of intestinal diameter before and after placement between the two methods(P=0.2),and there was no statistically significant difference in the probability of surgical complications after placement between the two methods(P= 0.81).Sensitivity analysis was performed after the exclusion of one by one of the included literatures,and the final research results showed no significant changes.Begg’s test showed no publication bias(P=0.075)in the funnel plot of abdominal pain and abdominal distension relief time.Conclusion: Existing evidence shows that placement of transanal drainage tube is more economical,faster and more successful in the treatment of obstructive colorectal cancer than Self-Expandable-Metal-Stent.However,it is slower relieving abdominal pain and distention and longer preoperative intestinal preparation time and hospitalization time than the stent during the treatment of obstructive colorectal cancer.