Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Crit Rev Oncol Hematol. 2020 Nov;155:103110. doi: 10.1016/j.critrevonc.2020.103110. Epub 2020 Sep 22.
Previous meta-analyses on palliative treatment of malignant colorectal obstruction with Self-Expandable Metal Stent (SEMS) or emergency surgery reported contradictory results for morbidity, and frequently included extracolonic obstruction. Therefore, the current meta-analysis aimed to exclusively analyze palliative treatment for primary obstructive colorectal cancer, with early complication rate as a primary outcome. A systematic literature search was performed on studies comparing palliative SEMS and emergency surgery. Corresponding authors were contacted for additional data. Eighteen studies were selected (1518 patients). Early complication rate was 13.6 % for SEMS and 25.5 % for emergency surgery (Odds Ratio (OR) 0.46, 95 % confidence interval (CI) 0.29-0.74). Mortality was 3.9 % and 9.4 % (OR 0.44, 0.28-0.69). Stomas were present in 14.3 % and 51.4 % of patients (OR 0.17, 0.09-0.31). More late complications occurred after SEMS (23.2 % versus 9.8 %, OR 2.55, 1.70-3.83), mostly due to SEMS obstruction. In conclusion, SEMS placement seems the preferred treatment of obstructing colorectal cancer in the palliative setting.
先前关于自膨式金属支架（SEMS）或紧急手术治疗恶性结直肠梗阻的荟萃分析报告显示，在发病率方面的结果存在矛盾，并且经常包括结外梗阻。因此，本次荟萃分析旨在专门分析原发性梗阻性结直肠癌的姑息治疗，以早期并发症发生率作为主要结局。对比较姑息性 SEMS 和紧急手术的研究进行了系统的文献检索，并联系了相应的作者以获取额外的数据。选择了 18 项研究（1518 名患者）。SEMS 的早期并发症发生率为 13.6％，紧急手术为 25.5％（优势比（OR）0.46，95％置信区间（CI）0.29-0.74）。死亡率分别为 3.9％和 9.4％（OR 0.44，0.28-0.69）。造口术在 14.3％和 51.4％的患者中存在（OR 0.17，0.09-0.31）。SEMS 后发生更多的晚期并发症（23.2％比 9.8％，OR 2.55，1.70-3.83），主要是由于 SEMS 阻塞。总之，在姑息治疗中，SEMS 放置似乎是治疗梗阻性结直肠癌的首选方法。
