title: Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis.
abstract: BACKGROUND
  Currently, no consensus exists on the best treatment strategy for acute malignant left-sided colonic obstruction. This systematic review and meta-analysis aims to compare the outcomes following the two surgical treatment options; primary resection versus colostomy creation as bridge to surgery.
  
  
  METHODS
  This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to minimize risk of bias. Pubmed, Embase and Cochrane Library were searched for all relevant literature. Methodological quality of included studies was assessed using the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95%CI) were calculated using random effects models.
  
  
  RESULTS
  Eight comparative studies were included, reporting on 2424 patients; 1973 patients were treated with primary resection and 451 patients with colostomy construction followed by elective resection. Meta-analysis showed no significant differences between both treatment groups regarding 30-day mortality and morbidity (OR = 0.77, 95%CI 0.3-1.96 and OR = 0.76, 95%CI 0.51-1.13, respectively). However, patients treated with a colostomy followed by elective resection had significantly more primary anastomoses constructed and were less likely to be left with a permanent colostomy (OR = 0.17, 95%CI 0.11-0.26 and OR = 0.22, 95%CI 0.11-0.46, respectively).
  
  
  CONCLUSIONS
  This systematic review provides an overview of all available literature on primary resection versus colostomy creation as bridge to surgery in patients with acute LSCO. Keeping the limitations of this study in mind, we conclude that a diverting colostomy as bridge to surgery is a safe and valid alternative for primary resection.
authors.affiliation: Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ, Amersfoort, The Netherlands.
authors.forename: Femke J
authors.initials: FJ
authors.lastname: Amelung
authors.affiliation: Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ, Amersfoort, The Netherlands.
authors.forename: Charlotte L J
authors.initials: CL
authors.lastname: Mulder
authors.affiliation: Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ, Amersfoort, The Netherlands.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Verheijen
authors.affiliation: Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ, Amersfoort, The Netherlands.
authors.forename: Werner A
authors.initials: WA
authors.lastname: Draaisma
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ, Amersfoort, The Netherlands. Electronic address: ecj.consten@meandermc.nl.
authors.forename: Esther C J
authors.initials: EC
authors.lastname: Consten
mesh_terms: D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery*; D003125:Colostomy; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*
keywords: Bridge to surgery; Colon cancer; Colostomy; Left-sided colonic obstruction; Primary resection