title: Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction.
abstract: OBJECTIVE
  Surgical decompression is the traditional treatment for acute colorectal cancer obstruction. In recent years, colorectal stenting has been used to relieve the obstruction. This study used meta-analytic techniques to compare colonic stenting versus surgical decompression for colorectal cancer obstruction.
  
  
  METHODS
  A comprehensive search of several databases was conducted. The search identified 321 potential abstracts and titles of which eight randomized trials involving 353 patients were retrieved in full text. A meta-analysis of the studies included was carried out to identify the differences in outcomes between the two procedures.
  
  
  RESULTS
  The pooled analysis showed no significant differences for mortality (odds ratio (OR) 0.91) and morbidity (OR 2.05) rates between the two strategies while the permanent stoma creation rate was significantly higher in the surgical group as compared to the stent group (OR 3.12). By comparing surgery and colonic stenting in studies which analyzed the use of stenting as a "bridge to surgery," the pooled analysis showed that primary anastomosis was more frequent in the stent group as compared to the surgical group (OR 0.42), and the stoma creation was more frequent in the surgical group as compared to the stent group (OR 2.36).
  
  
  CONCLUSIONS
  Our study suggested that, in patients with acute colorectal cancer obstruction, stent placement improved several outcomes, such as primary anastomosis, stoma formation, and permanent stoma, while it failed to show an improvement in mortality and morbidity risk.
authors.affiliation: Unit of Digestive Endoscopy, Department of Surgery, AUSL Bologna Bellaria Hospital, Via Altura, 40139, Bologna, Italy. cennamoit@yahoo.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Marco
authors.initials: M
authors.lastname: Bassi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Caro
authors.forename: Liza
authors.initials: L
authors.lastname: Ceroni
authors.forename: Antonella
authors.initials: A
authors.lastname: Maimone
authors.forename: Paolo
authors.initials: P
authors.lastname: Ravelli
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000714:Anastomosis, Surgical; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D054047:Surgical Stomas