Short-term and long-term outcomes of self-expandable metallic stent placement versus creation of a diverting stoma for obstructive colorectal cancer: A systematic review and meta-analysis

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2025-04-01 DOI:10.1002/ags3.70011

Thanakorn Yingruxpund, Akihisa Matsuda, Takeshi Yamada, Chaiya Chansai, Hiroshi Yoshida

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Abstract

Aim

A diverting stoma (DS) is often used as a bridge to surgery in patients with obstructive colorectal cancer (OCRC). However, the self-expandable metallic stent (SEMS) has emerged as a less invasive option. This systematic review and meta-analysis compared the efficacy and safety of the SEMS with that of a DS for OCRC.

Methods

An electronic literature search through to May 2024 was performed to identify studies that compared the SEMS and DS as a bridge to surgery in patients with OCRC. The primary outcomes were postoperative complications and mortality. Secondary outcomes included clinical success of decompression, surgical site infection, anastomotic leakage, bleeding, permanent stoma creation, locoregional recurrence, and 3-year overall survival. The data were pooled using a random-effects model. The results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Five non-randomized studies that included 977 patients (SEMS, n = 427; DS, n = 550) were included. Postoperative complications (OR 0.78, 95% CI 0.60–1.01, p = 0.06) and mortality (OR 1.15, 95% CI 0.61–2.16, p = 0.67) were comparable between the groups. SEMS placement had a significantly lower clinical success of decompression but reduced the risk of surgical site infection (OR 0.45, 95% CI 0.27–0.77, p = 0.003). There was no significant between-group difference in frequency of anastomotic leakage (p = 0.68), bleeding (p = 0.94), permanent stoma formation (p = 0.95), locoregional recurrence (p = 0.31), or 3-year overall survival (p = 0.98).

Conclusion

Although clinical success was inferior to DS, SEMS contributed to comparable outcomes including postoperative complications, mortality, and long-term outcomes, but significantly reduced SSI. These findings support the broader adoption of SEMS in clinical practice, particularly requiring minimized invasiveness and improving patient quality of life are prioritized.

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自膨胀金属支架置入与建立转移造口治疗梗阻性结直肠癌的短期和长期结果：一项系统回顾和荟萃分析

目的梗阻性结直肠癌（OCRC）患者常采用转移造口（DS）作为手术的桥梁。然而，自膨胀金属支架（SEMS）已成为一种侵入性较小的选择。本系统综述和荟萃分析比较了SEMS和DS治疗OCRC的疗效和安全性。方法通过电子文献检索到2024年5月，以确定比较SEMS和DS作为OCRC患者手术桥梁的研究。主要结局为术后并发症和死亡率。次要结局包括临床成功的减压、手术部位感染、吻合口漏、出血、永久性造口、局部复发和3年总生存。使用随机效应模型汇总数据。结果以95%置信区间（ci）的比值比（ORs）表示。结果5项非随机研究纳入977例患者(SEMS, n = 427；纳入DS （n = 550）。两组术后并发症（OR 0.78, 95% CI 0.60-1.01, p = 0.06）和死亡率（OR 1.15, 95% CI 0.61-2.16, p = 0.67）具有可比性。SEMS放置的临床减压成功率显著降低，但降低了手术部位感染的风险（OR 0.45, 95% CI 0.27-0.77, p = 0.003）。吻合口漏（p = 0.68）、出血（p = 0.94）、永久性造口（p = 0.95）、局部区域复发（p = 0.31）、3年总生存率（p = 0.98）两组间无显著差异。结论：虽然SEMS的临床成功率不如DS，但SEMS在包括术后并发症、死亡率和长期预后在内的结果上具有可比性，但SSI显著降低。这些发现支持在临床实践中更广泛地采用SEMS，特别是要求最小化侵入性和提高患者的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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