title: Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis.
abstract: We conducted a meta-analysis to compare the outcomes of a self-expanding metallic stent (SEMS) vs. surgery for the palliative treatment of colorectal obstruction caused by advanced colorectal malignancy. The databases of MEDLINE, EMBASE, Cochrane controlled trials registry and the Chinese Wanfang were retrieved (updated to 31 August 2011) to identify eligible studies. We calculated the odds ratio or weighted mean difference and its corresponding 95 % confidence interval. In total, nine primary studies were included in this analysis. The success rate of SEMS placement was 93.9 %, with short-term and long-term complication rates of 26.2 and 16.1 %, respectively. Combined analyses revealed that the SEMS group had a similar risk of short-term complications as the surgical group (P = 0.22). Moreover, SEMS was not associated with a higher mortality risk than surgical intervention (P = 0.22) and it required a significantly shorter hospitalization time (P < 0.01); however, SEMS patients had a higher risk of long-term complications (P = 0.03). Because of great heterogeneities between patients and chemoradiotherapy, we did not analyze the survival times of the two groups. These results support the feasibility of SEMS as a palliative treatment for malignant colorectal obstruction caused by incurable malignancy, as it requires shorter hospitalization and is followed by quick recovery. However, the risk of long-term complications such as perforation and stent migration should be borne in mind.
authors.affiliation: Department of General Surgery, Wuming County People's Hospital, 26 Yongning Road, 530100, Wuming, China.
authors.forename: Tian-wei
authors.initials: TW
authors.lastname: Liang
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.forename: Yong-cheng
authors.initials: YC
authors.lastname: Wei
authors.forename: Dong-xue
authors.initials: DX
authors.lastname: Yang
mesh_terms: D015179:Colorectal Neoplasms / Q000150:complications*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay; D016239:MEDLINE; D008670:Metals; D010166:Palliative Care; D012306:Risk; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D008670:Metals
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: Dis Colon Rectum. 2004 Nov;47(11):1889-97
references.pmid: 15622582
references.citation: Am J Gastroenterol. 2004 Oct;99(10):2051-7
references.pmid: 15447772
references.citation: Surg Endosc. 2004 Nov;18(11):1572-7
references.pmid: 15931483
references.citation: Anticancer Res. 2004 Jan-Feb;24(1):265-8
references.pmid: 15015606
references.citation: Ann Surg. 2007 Jul;246(1):24-30
references.pmid: 17592286
references.citation: Ann Intern Med. 2009 Aug 18;151(4):W65-94
references.pmid: 19622512
references.citation: Surg Endosc. 2004 Mar;18(3):421-6
references.pmid: 14735348
references.citation: Eur J Cancer. 2010 Nov;46(16):2879-88
references.pmid: 20605090
references.citation: BMJ. 1997 Sep 13;315(7109):629-34
references.pmid: 9310563
references.citation: Dis Colon Rectum. 2011 Aug;54(8):958-62
references.pmid: 21730783
references.citation: Pathophysiol Haemost Thromb. 2002 Sep-Dec;32(5-6):278-81
references.pmid: 13679657
references.citation: Jpn J Clin Oncol. 2010 Sep;40 Suppl 1:i38-43
references.pmid: 20870918
references.citation: Colorectal Dis. 2007 Jul;9(6):559-61
references.pmid: 17573753
references.citation: Dig Dis Sci. 2010 Jun;55(6):1732-7
references.pmid: 19693667
references.citation: Dis Colon Rectum. 2004 Sep;47(9):1455-61
references.pmid: 15486741
references.citation: Lancet Oncol. 2011 Apr;12(4):344-52
references.pmid: 21398178
references.citation: Br J Surg. 2007 Dec;94(12):1451-60
references.pmid: 17968980
references.citation: Biometrics. 1994 Dec;50(4):1088-101
references.pmid: 7786990
references.citation: Endoscopy. 2008 Mar;40(3):184-91
references.pmid: 18322873
references.citation: Ann Thorac Surg. 2004 Feb;77(2):745-53
references.pmid: 14759484
references.citation: BMC Med Res Methodol. 2005 Apr 20;5:13
references.pmid: 15840177
references.citation: Can J Surg. 2011 Apr;54(2):133-7
references.pmid: 21251422
references.citation: Int J Colorectal Dis. 2009 Jun;24(6):711-23
references.pmid: 19221766
references.citation: Gastrointest Endosc. 2011 Aug;74(2):321-327.e1-3
references.pmid: 21683354
references.citation: Ann R Coll Surg Engl. 2004 Mar;86(2):99-103
references.pmid: 15005927
references.citation: Dis Colon Rectum. 2005 May;48(5):988-95
references.pmid: 15785895
references.citation: Br J Surg. 2003 Nov;90(11):1429-33
references.pmid: 14598426
references.citation: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references.pmid: 20610543
references.citation: Surg Endosc. 2011 Jul;25(7):2203-9
references.pmid: 21293882
references.citation: Br J Surg. 1994 Sep;81(9):1270-6
references.pmid: 7953385
references.citation: Surg Oncol. 2004 Aug-Nov;13(2-3):149-57
references.pmid: 15572097
references.citation: Surg Endosc. 2012 Jan;26(1):110-9
references.pmid: 21789642
references.citation: Surg Endosc. 2011 Jun;25(6):1814-21
references.pmid: 21170659
references.citation: Surg Today. 2009;39(7):575-9
references.pmid: 19562444
references.citation: Surg Endosc. 2012 Feb;26(2):323-9
references.pmid: 21898024