Department of Gastrointestinal Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan Province, China.
State Key Laboratory of Biotherapy West China Hospital, West China Medical School, Sichuan University, Chengdu, 610500, Sichuan Province, China.
World J Emerg Surg. 2021 Mar 18;16(1):11. doi: 10.1186/s13017-021-00355-2.
There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the 5-year overall survival (OS) and disease-free survival (DFS) of several treatment strategies for acute left malignant colonic obstruction.
We searched for articles published in PubMed, Embase (Ovid), MEDLINE (Ovid), Web of Science, and Cochrane Library between January 1, 2000, and July 1, 2020. We screened out the literature comparing different treatment strategies. Evaluate the primary and secondary outcomes of different treatment strategies. The network meta-analysis summarizes the hazard ratio, odds ratio, mean difference, and its 95% confidence interval.
The network meta-analysis involved 48 articles, including 8 (randomized controlled trials) RCTs and 40 non-RCTs. Primary outcomes: the 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES.
compared with emergency resection (ER) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies.
Comprehensive literature research, we find that CS-BTS and DS-BTS strategies can bring better 5-year OS and DFS than ER. DS-BTS strategies have a better 5-year OS than CS-BTS strategies. Without considering the hospital stays, DS-BTS strategy is the best choice.
对于急性左半结肠癌性梗阻的不同治疗策略的疗效存在争议。本研究调查了几种急性左半结肠癌性梗阻治疗策略的 5 年总生存率（OS）和无病生存率（DFS）。
我们在 PubMed、Embase（Ovid）、MEDLINE（Ovid）、Web of Science 和 Cochrane Library 中检索了 2000 年 1 月 1 日至 2020 年 7 月 1 日期间发表的文章。我们筛选出比较不同治疗策略的文献。评估不同治疗策略的主要和次要结局。网络荟萃分析总结了危险比、优势比、均数差及其 95%置信区间。
网络荟萃分析共纳入 48 篇文献，其中 8 篇（随机对照试验）RCT 和 40 篇非 RCT。主要结局：CS-BTS 策略和 DS-BTS 策略的 5 年 OS 和 DFS 显著优于 ES 策略，DS-BTS 策略的 5 年 OS 显著优于 CS-BTS。TCT-BTS 的长期生存与 CS-BTS 和 ES 无显著差异。
与急诊切除术（ER）策略相比，结肠支架桥接手术（CS-BTS）和经肛直肠管桥接手术（TCT-BTS）策略可显著提高一期吻合率，CS-BTS 和减压造口桥接手术（DS-BTS）策略可显著降低死亡率，CS-BTS 策略可显著降低永久性造口率。DS-BTS 的住院时间明显长于其他策略。几种治疗策略的吻合口漏水平无显著差异。
综合文献研究，我们发现 CS-BTS 和 DS-BTS 策略可带来优于 ER 的 5 年 OS 和 DFS。DS-BTS 策略比 CS-BTS 策略有更好的 5 年 OS。不考虑住院时间，DS-BTS 策略是最佳选择。
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