Which treatment strategy is optimal for acute left-sided malignant colonic obstruction? A Bayesian meta-analysis.
Int J Colorectal Dis
; 38(1): 217, 2023 Aug 17.
Article
em En
| MEDLINE
| ID: mdl-37589792
ABSTRACT
PURPOSE:
This study aimed to determine the best treatment for acute left-sided malignant colonic obstruction (ALMCO) among emergency surgery (ES), self-expanding metallic stent (SEMS), transanal drainage tube (TD), and decompressive stoma (DS).METHOD:
Articles that compared two or more treatments of ALMCO were searched from PubMed, Cochrane Library, and Embase. Network meta-analyses were performed to calculate the outcomes of primary anastomosis, stoma creation, morbidity, mortality, and 5-year survival.RESULTS:
Fifty-one articles met inclusion criteria. TD was the optimal treatment in performing primary anastomosis [probability of ranking first (Pro-1) 0.96], while ES was the worst [probability of ranking fourth (Pro-4) 0.99]. More permanent stoma was formed in ES and TD groups than in SEMS and DS groups [OR (95%CI) TD vs SEMS 4.12 (1.89, 9.45); TD vs DS 3.39 (1.46, 8.75); ES vs DS 2.55 (1.73, 4.17); SEMS vs ES 0.33 (0.24, 0.42)]. More morbidity occurred in ES group than in SEMS group [OR (95%CI) ES vs SEMS 1.44 (1.14, 1.82)]. Besides, SEMS was ranked first in avoiding infection (Pro-4 0.95). For in-hospital mortality, ES was ranked first (Pro-1 0.93). TD was ranked first in recurrence (Pro-1 0.97) and metastasis (Pro-1 0.98). There was no discrepancy in 5-year overall and disease-free survival among all strategies.CONCLUSION:
SEMS as a bridge to surgery reduces stoma formation, and morbidity especially the infection rate with relatively great oncological outcomes. Therefore, SEMS should be recommended first for ALMCO in the medical center with experience and conditions.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Colo
/
Obstrução Intestinal
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article