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

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.

MASCC Multidisciplinary Evidence-Based Recommendations for the Management of Malignant Bowel Obstruction in Advanced Cancer

“…Results showed that 30-day mortality was higher in those patients undergoing a surgical procedure (OR 0.4; 95% CI 0.28-0.69). 103 Early complications were more frequent in the surgical group, whereas late complications occurred more frequently after SEMS, mainly re-obstructions. Another meta-analysis in the same setting only including randomized controlled trials (four studies, 125 patients), showed no differences in 30-day mortality or mean survival between those patients undergoing SEMS or emergency surgery, with a shorter hospital stay in SEMS group.…”

Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients

“…Although the analysis showed that SEMS provided shorter operative and recovery time, and comparable complication and 30-day mortality rates, a higher clinical success rate was reported in the primary surgery group. A more recent systematic review and meta-analysis by Veld et al [ 22 ] included 18 studies with a sum of 1,518 subjects and exclusively focused on the early postoperative period. The authors concluded that SEMS was superior to primary surgery in the palliative setting mainly due to lower complication rates and faster recovery.…”

MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

“…In a meta-analysis of patients with large BO caused by colorectal cancer undergoing SEMS placement or emergency surgery with palliative intent, eighteen studies (randomized controlled trials and comparative observational studies) with 1518 patients were included. Results showed that 30-day mortality was higher in those patients undergoing a surgical procedure (OR 0.4; 95% CI 0.28-0.69) [103]. Early complications were more frequent in the surgical group, whereas late complications occurred more frequently after SEMS, mainly re-obstructions.…”