Takahashi Hidena, Okabayashi Koji, Tsuruta Masashi, Hasegawa Hirotoshi, Yahagi Masashi, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, 35 Shinanotmachi, Shinjuku-ku, Tokyo, Japan,
World J Surg. 2015 Aug;39(8):2037-44. doi: 10.1007/s00268-015-3068-7.
Although self-expanding metallic stents (SEMS) are useful tools for relieving large bowel obstructions in patients with colorectal cancer (CRC), their efficacy in a palliative setting has not been validated. This meta-analysis aimed to evaluate the feasibility of SEMS as a palliation for unresectable CRC patients with bowel obstructions and to determine their contribution to the prognosis of CRC, compared with surgical intervention.
We conducted a literature search of the PubMed and Cochrane Library databases. We selected all controlled trials that compared SEMS with surgical interventions as palliative treatments in unresectable obstructive CRC patients. The primary outcome was early complications, and the secondary outcomes were mortality, other morbidities, and long-term survival rates.
Ten studies met our inclusion criteria. SEMS significantly reduced the risk of early complications (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.20-0.58%; P<0.01), mortality (OR 0.31; 95% CI 0.15%-0.64%; P<0.01), and stoma creation (OR 0.19; 95% CI 0.12-0.28%; P<0.01). Although SEMS placement was significantly associated with a higher risk of perforation of the large bowel (OR 5.25 95% CI 2.00-13.78%; P<0.01) and late complications (OR 1.94; 95% CI 0.90-4.19%; P=0.03), it also contributed significantly to better long-term survival (hazard ratio 0.46; 95% CI 0.31-0.68%; P<0.01).
Compared with surgical intervention, SEMS could provide feasible palliation for patients with bowel obstructions and unresectable CRC, because of their acceptable morbidity rates and better patient prognoses.
尽管自膨式金属支架（SEMS）是缓解结直肠癌（CRC）患者大肠梗阻的有用工具，但其在姑息治疗中的疗效尚未得到验证。本荟萃分析旨在评估SEMS作为无法切除的CRC肠梗阻患者姑息治疗手段的可行性，并确定与手术干预相比，其对CRC预后的影响。
我们对PubMed和Cochrane图书馆数据库进行了文献检索。我们选择了所有比较SEMS与手术干预作为无法切除的梗阻性CRC患者姑息治疗方法的对照试验。主要结局是早期并发症，次要结局是死亡率、其他发病率和长期生存率。
十项研究符合我们的纳入标准。SEMS显著降低了早期并发症风险（优势比[OR]0.34；95%置信区间[CI]0.20 - 0.58%；P<0.01）、死亡率（OR 0.31；95% CI 0.15% - 0.64%；P<0.01）和造口形成率（OR 0.19；95% CI 0.12 - 0.28%；P<0.01）。尽管放置SEMS与大肠穿孔风险较高（OR 5.25，95% CI 2.00 - 13.78%；P<0.01）和晚期并发症显著相关（OR 1.94；95% CI 0.90 - 4.19%；P = 0.03），但它也对更好的长期生存有显著贡献（风险比0.46；95% CI 0.31 - 0.68%；P<0.01）。
与手术干预相比，SEMS可为肠梗阻且无法切除的CRC患者提供可行的姑息治疗，因为其发病率可接受且患者预后较好。
