Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

F. J. Amelung, H. W. L. de Beaufort, P. D. Siersema, P. M. Verheijen, E. C. J. Consten*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

23 Citations (Scopus)

Abstract

No consensus exists on the optimal treatment of acute malignant right-sided colonic obstruction (RSCO). This systematic review aims to compare procedure-related mortality and morbidity rates between primary resection and stent placement as a bridge to surgery followed by elective resection for patients with acute RSCO.

PubMed, Embase and Cochrane library were searched for all relevant literature. Primary endpoints were procedure-related mortality and morbidity. Methodological quality of the included studies was assessed using the MINORS criteria.

Fourteen cohort studies were eligible for analysis. A total of 2873 patients were included in the acute resection group and 155 patients in the stent group. Mean mortality rate for patients who underwent acute resection with primary anastomosis was 10.8 % (8.1-18.5 %). Overall mortality for patients initially treated with a colonic stent followed with elective resection was 0 %. Major morbidity was 23.9 % (9.3-35.6 %) and 0.8 % (0-4.8 %), respectively. Both mortality and major morbidity were significantly different. In addition, stent placement shows lower rates of anastomotic leakages (0 vs 9.1 %) and fewer permanent ileostomies (0 vs 1.0 %).

Primary resection for patients with acute RSCO seems to be associated with higher mortality and major morbidity rates than stent placement and elective resection. In addition, stent placement resulted in fewer anastomotic leakages and permanent ileostomies. However, as no high-level studies are available on the optimal treatment of RSCO and proximal stenting is considered technically challenging, future comparative studies are warranted for the development of an evidence-based clinical decision guideline.

Original languageEnglish
Pages (from-to)1147-1155
Number of pages9
JournalInternational Journal of Colorectal Disease
Volume30
Issue number9
DOIs
Publication statusPublished - Sep-2015
Externally publishedYes

Keywords

  • Colonic cancer
  • Obstruction
  • Acute primary resection
  • Stenting
  • Bridge to surgery
  • LARGE-BOWEL OBSTRUCTION
  • EXPANDING METALLIC STENTS
  • MALIGNANT COLORECTAL OBSTRUCTION
  • PROXIMAL COLON
  • RIGHT HEMICOLECTOMY
  • CANCER
  • MANAGEMENT
  • CARCINOMA
  • OUTCOMES
  • PLACEMENT

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