The Comparison Of Colonic Stenting As Bridge To Surgery Vs Emergency Operation For The Treatment Of Obstructed Left Colon Cancer:a Meta-analysis

PurposeColonic stenting as bridge to surgery(SBTS)is an effective method for obstructive left colon cancer,but the curative effect of stent is still controversial.This paper discusses the clinical value of sequential surgery(SBTS group)and emergency surgery(ES group)by Meta analysis.MethodsPub Med,Embase,Cochrane Library,Chinese Biomedical Database(CBM),China National Knowledge Internet(CNKI),Wanfang Database System and other Chinese and English databases were searched for relevant literature on colonic stenting as bridge to surgery(SBTS group)and emergency surgery(ES group)in the treatment of obstructive left colorectal cancer.The retrieval period was from 1991 to December 2020,and Rev Man 5.4 software and R language were used for statistical analysis of the two treatment regimens.The quality of literature was evaluated and sensitivity analysis was performed.The feasibility of intestinal stent,treatment details,surgical complications and long-term outcomes were observed.ResultsA total of 8 randomized controlled trials involving 524 CRC patients from 6 countries were included,including 267 in SBTS group and 257 in ES group.The technical success rate of stent was 84 %(47 %-95 %)and 95 % CI(0.68,0.93).The clinical success rate was 78 %(40 %-95 %)and 95 % CI(0.63,0.88).Perforation rate was 2%(9%-13 %)and 95 % CI(0.01,0.05).Migration rate was 6 %(7 %-11 %)and 95 % CI(0.04,0.10).Compared with ES group,SBTS group had no significant statistical differences in operation time(MD =-13.88;95 % CI :-29.88,2.12;P = 0.09),hospitalization time(MD = 1.05;95 % CI :-2.24,4.35;P = 0.53),anastomotic leakage(RR = 0.80;95 % CI : 0.39,1.64;P = 0.55),recurrence rate(RR = 0.78,95% CI: 0.45-1.35,P = 0.37)and perioperative mortality(RR = 0.70;95 % CI :0.39,1.26;P = 0.24),but the primary anastomosis rate(RR = 1.53;95 % CI : 1.27,1.83;P <0.00001),stoma rate(RR = 0.46;95 % CI : 0.35,0.61;P < 0.00001),incision infection(RR = 0.48;95 % CI : 0.28,0.82;P = 0.007),total complication rate(RR = 0.60;95 % CI : 0.49,0.73;P <0.00001)and permanent stoma rate(RR = 0.71;95 % CI : 0.53,0.93;P = 0.02)were significantly different,it can improve the primary anastomosis rate and reduce the incidence of intraoperative stoma,incision infection,total complications and permanent stoma.ConclusionColonic stenting as bridge to surgery is feasible for obstructive left colon cancer,and this treatment can improve the first-stage anastomosis rate.The incidence of intraoperative stoma,wound infection,overall complications and permanent stoma was reduced,but there was no significant effect on operation time,hospitalization days,anastomotic leakage,recurrence rate and perioperative mortality.