title: Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the effects of emergent preoperative self-expandable metallic stent (SEMS) vs emergent surgery for acute left-sided malignant colonic obstruction.
  
  
  METHODS
  Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated.
  
  
  RESULTS
  Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI: 0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI: 0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI: 0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI: 0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI: 0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13).
  
  
  CONCLUSIONS
  SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.
authors.affiliation: Department of General Surgery, Renji Hospital-Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Guang-Yao
authors.initials: GY
authors.lastname: Ye
authors.forename: Zhe
authors.initials: Z
authors.lastname: Cui
authors.forename: Lu
authors.initials: L
authors.lastname: Chen
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
mesh_terms: D003082:Colectomy / Q000009:adverse effects / Q000401:mortality; D015179:Colorectal Neoplasms / Q000150:complications*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome
keywords: Acute obstruction; Colonic cancer; Meta-analysis; Self-expandable metallic stent; Stoma placement; Systematic review