title: Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis.
abstract: OBJECTIVE
  The purpose of this paper is to evaluate the efficacy and safety of colonic stenting as a bridge to surgery versus emergency surgery for acute left-sided malignant colonic obstruction.
  
  
  METHODS
  Randomized clinical trials (RCT) that compared the efficacy or safety of preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction were searched in medical databases, including PubMed, OVID, EMBASE, and the Cochrane Library. Statistical heterogeneity between trials was evaluated by Revman 5.1 and was considered to exist at I(2) > 50%.
  
  
  RESULTS
  Seven RCTs were identified. There was a total of 382 patients, 195 who received a colonic stent and 187 who received emergency surgery. Compared with the emergency surgery group, the colonic stent group achieved significantly more favorable rates of permanent stoma, primary anastomosis, wound infection, and overall complications. There was no significant difference between the two groups in anastomotic leakage, mortality, or intra-abdominal infection. Inspection of funnel plots for all outcome measures did not reveal evidence of publication bias.
  
  
  CONCLUSIONS
  Self-expanding metal stents serve as a safe and effective bridge to subsequent surgery in patients with obstructing left-sided colon cancer. They can significantly improve one-stage surgery rates, and decrease the rates of permanent stoma and wound infection.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou City, 310006, Zhejiang Province, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Huang
authors.forename: Bin
authors.initials: B
authors.lastname: Lv
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.forename: Lina
authors.initials: L
authors.lastname: Meng
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology