Preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the efficacy and safety of preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction based on literature. Methods The randomized clinical trials (RCT) on the subject were retrieved from PubMed,OVID,EMBASE,Cochrane library,CNKI,Wanfang data and VIP Chinese Scientific and Technologic Periodical Database.Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P ＜ 0.1.Heterogeneity of the included articles was tested,which was used to select proper effect model.Publication bias was investigated through visual inspection of funnel plots.Results Five RCT including 283 cases were analyzed,in which 145 patients received preoperative colonic stenting and 138 received emergency surgery.Compared with those of emergency surgery groups,the total OR of permanent stoma,one-stage operation,and infection of preoperative colonic stenting group were 0.28 (95％ CI0.12 - 0.62,P =0.002),2.13 (95 ％ CI1.28 - 3.55,P =0.004) and 0.25 (95％ CI0.08 - 0.80,P =0.02),respectively.There were no significant differences between 2 groups in anastomotic leakage,mortality,intra-abdominal infection,or overall morbidity.OR were 0.70 (95％ CI0.29 - 1.71,P =0.44),1.17 (95％ CI0.49 -2.79,P=0.72),0.27 (95％CI0.03-2.65,P=0.26) and 0.32 (95％CI0.07-1.42,P=0.13),respectively.Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias.Conclusion Preoperative colonic stenting significantly improves one-stage operation and decrease the rates of permanent stoma and wound infection.However,large-scale and high-quality RCTs are further needed.