| Research background and purpose:The left colon cancer(descending colon and sigmoid colon)often have acute intestinal obstruction caused by coarctation of the intestinal lumen as the main clinical manifestation.There is no consensus on the management strategy of this type of patients,and there is controversy.At present,the common treatment strategies in clinical practice are Colonic stent-Bridge to surgery(CS-BTS),Transanal decompression tube-Bridge to surgery(TDT-BTS),Decompressing stoma-Bridge to Surgery(DS-BTS)and Emergency resection(ER).Whether there are differences in survival prognosis,complications,recovery time,and health economics among the four different treatment strategies,and whether there is an optimal treatment option,is the starting point of this study.The purpose of this study was to investigate the differences in the prognosis of these four treatment strategies for acute left-sided malignant colonic obstruction,and to identify the optimal treatment strategy.Materials and Methods:We searched PubMed,Embase,Web of Science,Medline and Cochrane Library for articles published between 1 January 2000 and 1 July 2020.We screened literature comparing the outcomes of the above four treatment strategies for acute left-sided malignant colonic obstruction.The primary and secondary outcomes of the four treatment strategies were evaluated.The primary outcomes included:5-year overall survival(OS)and disease-free survival(DFS);the secondary outcomes included:primary anastomosis rate,perioperative mortality,incidence of anastomotic leakage,permanent stoma rate,and average hospital stay.The hazard ratio(HR),odds ratio(OR),mean difference(MD)and corresponding 95%confidence interval(CI)of the corresponding indicators were summarized using standard network meta-analysis methods.Result:1.A total of 48 articles were included in this network Mata analysis,including 8 randomized controlled trials(RCTs)articles and 40 non-RCTs articles;2.The 5-year OS of both CS-BTS and DS-BTS strategies were significantly better than ER strategy(HR and 95%CI of ER Vs CS-BTS and DS-BTS were 1.14(1.04-1.26)and 1.29(1.13-1.48),respectively),and the 5-year OS of the DS-BTS strategy is better than that of the CS-BTS strategy(HR and 95%CI of DS-BTS Vs CS-BTS are 0.88(0.800.98));3.The 5-year DFS of both CS-BTS and DS-BTS strategies was significantly better than that of ER strategies(HR and 95%CI of ER Vs CS-BTS and DS-BTS were 1.12(1.06-1.35)and 1.23(1.06-1.44),respectively);4.The primary anastomosis rate of the CS-BTS and TDT-BTS strategies were significantly higher than those of the ER strategy(OR and 95%CI of ER Vs CS-BTS and TDT-BTS were 0.23(0.13-0.38)and 0.23(0.06-0.84),respectively);5.The perioperative mortality of CS-BTS and DS-BTS strategies was significantly lower than that of ER strategy(OR and 95%CI of ER Vs CS-BTS and DS-BTS were 2.13(1.59-3.22)and 3.03(1.75-6.67),respectively),the CS-BTS strategy had significantly less permanent stoma rate than the ER strategy(OR and 95%CI for ER Vs CS-BTS was 3.28(1.75-6.41));6.The average hospital stay of the DS-BTS strategy was significantly longer than that of the other three treatment strategies;7.There was no significant difference in the incidence of anastomotic leakage among the four treatment strategies.Conclusion:Comprehensive literature research,we find that CS-BTS and DS-BTS strategies can bring better 5-year OS and DFS than ER strategy.DS-BTS strategy has a better 5-year OS than CS-BTS strategy.Without considering the hospital stays,DS-BTS strategy is the best choice. |
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