Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction

Background:

Use of self-expanding metallic stents (SEMS) as a bridge to surgery has been suggested as an alternative management for acute malignant left-sided colonic obstruction, as emergency surgery has a high risk of morbidity and mortality. This meta-analysis evaluated high-quality evidence comparing preoperative SEMS with emergency surgery.

Results:

Four RCTs with 234 patients were included..........Three trials were stopped prematurely, one because the emergency surgery group had a significantly increased anastomotic leak rate, and two others because of stent-related complications and increased 30-day morbidity following SEMS management.......

EvidenceUpdates - abstract/commentaries: Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre r

 Note: this study was originally published in The Lancet and involved patients in 25 hospitals; the study pertained to left-sided colorectal cancers however may be appropriate/of interest to other cancer patient populations; commentaries are included from a variety of professions including gastroenterologist, oncologists...

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BACKGROUND: Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction, but its benefits are uncertain. We aimed to establish whether colonic stenting has better health outcomes than does emergency surgery.

Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial : The Lancet Oncology

Background

Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction, but its benefits are uncertain.
We aimed to establish whether colonic stenting has better health outcomes than does emergency surgery.