Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis
Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis
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DOI：
10.1007/s00464-011-1835-6
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发表时间：
2012-01-01
影响因子：
3.1
通讯作者：
Chen, Yue-Xiang
中科院分区：
文献类型：
--
作者：
Zhang, Yi;Shi, Jian;Chen, Yue-Xiang
使用结肠支架作为手术的桥梁，旨在为患者提供选择性一期手术切除，同时减少造口和术后并发症。本研究采用荟萃分析技术比较支架作为手术和急诊手术治疗梗阻性结直肠癌的效果。对Medline、Embase、Cochrane对照试验注册库和中国生物医学文献数据库进行文献检索，比较支架作为梗阻性结直肠癌手术与急诊手术之间的桥梁的所有研究。对纳入的研究进行了荟萃分析，以确定两种方法之间结果的差异。8项研究符合纳入标准，并报道了601例患者的结果，其中232例（38.6%）接受了支架植入，369例（61.4%）接受了紧急手术。支架组需要重症监护的患者较少（风险比[RR]， 0.42； 95%可信区间[CI]， 0.19-0.93; p = 0.03）和造口（RR, 0.70; 95% CI, 0.50-0.99; p = 0.04）。支架组一期吻合率较高（RR, 1.62; 95% CI, 1.21-2.16; p = 0.001）。支架置入减少了吻合口瘘（RR, 0.31; 95% CI, 0.14-0.69; p = 0.004）等总并发症（RR, 0.42; 95% CI, 0.24-0.71; p = 0.001）。择期手术前支架置入对死亡率和长期生存率没有不利影响。使用支架作为梗阻性左侧结直肠癌手术的桥梁可以增加原发性吻合的机会，减少造口的需要和术后并发症。术后植入支架对围手术期死亡率和远期生存率无影响。
The use of a colonic stent as a bridge to surgery aims to provide patients with elective one-stage surgical resection while reducing stoma creation and postoperative complications. This study used meta-analytic techniques to compare the outcomes of stent use as a bridge to surgery and emergency surgery in the management of obstructive colorectal cancer.A literature search of Medline, Embase, Cochrane controlled trials registry, and the Chinese Biomedical Literature Database was performed on all studies comparing stent as a bridge to surgery and emergency surgery for obstructive colorectal cancer. A meta-analysis of the included studies was carried out to identify the differences in outcomes between the two procedures.Eight studies matched the criteria for inclusion and reported on the outcomes of 601 patients, of whom 232 (38.6%) underwent stent insertion and 369 (61.4%) underwent emergency surgery. Fewer patients in the stent group needed intensive care (risk ratio [RR], 0.42; 95% confidence interval [CI], 0.19-0.93; p = 0.03) and stoma creation (RR, 0.70; 95% CI, 0.50-0.99; p = 0.04). The primary anastomosis rate in the stent group was higher (RR, 1.62; 95% CI, 1.21-2.16; p = 0.001). Overall complications (RR, 0.42; 95% CI, 0.24-0.71; p = 0.001), including anastomotic leakage (RR, 0.31; 95% CI, 0.14-0.69; p = 0.004), were reduced by stent insertion. Stent placement before elective surgery did not adversely affect mortality and long-term survival.The use of a stent as a bridge to surgery for obstructive left-sided colorectal cancer could increase the chance of primary anastomosis and reduce the need for stoma creation and postprocedural complications. Stent insertion before subsequent surgery has no effect on perioperative mortality and long-term survival.