title: Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for malignant large-bowel obstruction: a meta-analysis.
abstract: BACKGROUND
  The short-term safety and efficacy of insertion of a self-expandable metallic colonic stent followed by elective surgery, bridge to surgery (BTS), for malignant large-bowel obstruction (MLBO) have been well described. However, long-term oncological outcomes are still debated. Hence, this study is conducted to evaluate long-term outcomes of colonic stent insertion followed by surgery for MLBO.
  
  
  METHODS
  A comprehensive electronic literature search through May 2014 was performed to identify studies comparing long-term outcomes between BTS and emergency surgery for MLBO. The main outcome measures were overall survival (OS), disease-free survival (DFS), and recurrence. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) with 95 % confidence intervals (95 % CIs).
  
  
  RESULTS
  There were 11 studies that matched the criteria for inclusion, yielding a total of 1136 patients, of whom 432 (38.0 %) underwent BTS and 704 (62.0 %) underwent emergency surgery. In OS analyses of all patients and patients who underwent curative resection, BTS was similar to emergency surgery [(RR = 0.95; 95 % CI 0.75-1.21; P = 0.66) (RR = 0.96; 95 % CI 0.67-1.37; P = 0.82), respectively]. DFS (RR = 1.06; 95 % CI 0.91-1.24; P = 0.43) and recurrence (RR = 1.13; 95 % CI 0.82-1.54; P = 0.46) did not differ significantly between the BTS and emergency surgery groups.
  
  
  CONCLUSIONS
  Results of this meta-analysis on long-term as well as well-described short-term outcomes suggest that BTS could be a promising alternative strategy for MLBO patients.
authors.affiliation: Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan, a-matsu@nms.ac.jp.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.forename: Masao
authors.initials: M
authors.lastname: Miyashita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakurazawa
authors.forename: Goro
authors.initials: G
authors.lastname: Takahashi
authors.forename: Taro
authors.initials: T
authors.lastname: Kishi
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D015179:Colorectal Neoplasms / Q000150:complications; D004638:Emergency Treatment / Q000295:instrumentation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome