Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction.
BACKGROUND
Surgical strategy for acute colorectal obstruction due to colorectal cancer remains controversial. One-, two- and three-stage surgical procedures, and preoperative stenting of the stenosis as a bridge to surgery, are available.


METHODS
A systematic review was conducted, searching MEDLINE, EMBASE and CENTRAL, as well as bibliographies of included studies, to identify randomized and non-randomized controlled trials that compared two or more surgical procedures in acute colonic obstruction.


RESULTS
After screening 1748 titles and abstracts, 209 were selected for full text assessment; 29 studies with 2286 patients were finally included. In general, the quality of the studies was limited, with only three randomized trials. Eight non-randomized studies comparing one-stage with two- or three-stage surgery consistently favoured a one-stage procedure in terms of mortality (relative risk difference from - 2 to - 27 per cent), but reported morbidity rates were not different. Trials of different one-stage procedures (segmental and total/subtotal colectomy) showed none to be clearly superior. Stenting procedures were superior to non-stenting treatments.


CONCLUSIONS
One-stage surgery appears to be superior to two- or three-stage procedures. Stenting is a promising option, allowing the resection to be carried out in an elective setting.
Breitenstein
S
S
Department of Visceral and Transplantation Surgery, Zurich, Switzerland.
Rickenbacher
A
A
Berdajs
D
D
Puhan
M
M
Clavien
P-A
PA
Demartines
N
N
D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods / Q000401:mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D015607:Stents