Self-expandable metal stent (SEMS) placement or emergency surgery as palliative treatment for obstructive colorectal cancer: A systematic review and meta-analysis

Joyce Veld, Devica Umans, Emo van Halsema, Femke Amelung, Dalia Fernandes, Mei Sze Lee, Douglas Stupart, Javier Suarez, Yuichi Tomiki, Willem Bemelman, Paul Fockens, Esther Consten, Pieter Tanis, Jeanin van Hooft*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

1 Citation (Scopus)

Abstract

Previous meta-analyses on palliative treatment of malignant colorectal obstruction with Self-Expandable Metal Stent (SEMS) or emergency surgery reported contradictory results for morbidity, and frequently included extracolonic obstruction. Therefore, the current meta-analysis aimed to exclusively analyze palliative treatment for primary obstructive colorectal cancer, with early complication rate as a primary outcome. A systematic literature search was performed on studies comparing palliative SEMS and emergency surgery. Corresponding authors were contacted for additional data. Eighteen studies were selected (1518 patients). Early complication rate was 13.6 % for SEMS and 25.5 % for emergency surgery (Odds Ratio (OR) 0.46, 95 % confidence interval (CI) 0.29-0.74). Mortality was 3.9 % and 9.4 % (OR 0.44, 0.28-0.69). Stomas were present in 14.3 % and 51.4 % of patients (OR 0.17, 0.09-0.31). More late complications occurred after SEMS (23.2 % versus 9.8 %, OR 2.55, 1.70-3.83), mostly due to SEMS obstruction. In conclusion, SEMS placement seems the preferred treatment of obstructing colorectal cancer in the palliative setting.

Original languageEnglish
Article number103110
Number of pages12
JournalCritical Reviews in Oncology/Hematology
Volume155
DOIs
Publication statusPublished - Nov-2020

Keywords

  • Obstructive colorectal cancer
  • Self-Expandable metal stent
  • Emergency surgery
  • Palliation
  • MALIGNANT COLONIC OBSTRUCTION
  • LONG-TERM OUTCOMES
  • PRIMARY TUMOR
  • ENDOSCOPIC STENT
  • RESECTION
  • COLOSTOMY
  • CHEMOTHERAPY
  • MANAGEMENT
  • BRIDGE
  • BIAS

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