Department of Surgery, Meander Medical Center, Maatweg 3, 3813TZ Amersfoort, The Netherlands.
Department of Surgery, Academic Medical Center, Meiberglaan 9, 1105 AZ, Amsterdam, The Netherlands.
Crit Rev Oncol Hematol. 2018 Nov;131:66-75. doi: 10.1016/j.critrevonc.2018.08.003. Epub 2018 Sep 4.
This meta-analysis aims to determine the long-term oncological outcomes of SEMS as bridge to surgery (BTS) versus emergency surgery (ES). A systematic search without restrictions was conducted, and all studies comparing SEMS with ES reporting on long-term outcomes were included. Methodological quality was assessed using the appropriate tools. Twenty-one comparative studies were selected, reporting on 1919 patients. Meta-analysis showed no significant difference regarding three- and five-year overall survival (OR = 0·85 (0·68-1·08) and OR = 1·04 (0·68-1·57), respectively), disease-free survival (OR = 0·96 (0·73-1·26) and OR = 0·86 (0·54-1·36), respectively) and local recurrence rate (OR = 1·32 (0·78-2·23)). Permanent stomas were significantly lower in the SEMS group (OR 0·49 (0·32-0·74)). Sensitivity analysis on three-year survival showed opposite outcomes, with a trend towards worse survival in the SEMS group when only RCTs are taken into account. In conclusion, when in experienced hands, SEMS placement as BTS seems oncologically safe.
本荟萃分析旨在确定支架内金属胆道塑料覆膜可取出支架（SEMS）作为桥接手术（BTS）与紧急手术（ES）的长期肿瘤学结局。系统检索无限制，并纳入了所有比较 SEMS 与 ES 报告长期结局的研究。使用适当的工具评估方法学质量。选择了 21 项比较研究，报告了 1919 名患者。荟萃分析显示，在 3 年和 5 年总生存率（OR=0.85（0.68-1.08）和 OR=1.04（0.68-1.57））、无病生存率（OR=0.96（0.73-1.26）和 OR=0.86（0.54-1.36））和局部复发率（OR=1.32（0.78-2.23））方面，差异无统计学意义。SEMS 组永久性造口术显著降低（OR 0.49（0.32-0.74））。对 3 年生存率的敏感性分析显示了相反的结果，当仅考虑 RCT 时，SEMS 组的生存趋势较差。总之，在经验丰富的医生手中，SEMS 作为 BTS 放置在肿瘤学上似乎是安全的。
