Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Saudi J Gastroenterol. 2021 May-Jun;27(3):127-135. doi: 10.4103/sjg.sjg_506_20.
With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients.
We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates.
We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I = 79.3%, P < 0.001).
The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.
对于直肠或直肠乙状结肠癌所致的急性梗阻，自膨式金属支架的安全性和成功率存在争议。本系统综述的目的是综合现有证据，评估支架置入术治疗此类患者的结局和并发症发生率。
我们使用合适的关键词在 PubMed 上进行文献检索，并对纳入文献进行手动参考文献筛选。文章筛选、数据提取和质量评估由四位独立的审稿人完成。对主要结局指标（技术和临床成功率及并发症发生率）进行了荟萃分析。
我们在检索中找到了 962 篇文章。经过纳入和排除标准的筛选，共有 32 篇文章纳入荟萃分析。26 项报道技术成功率的研究汇总后的技术成功率为 97%（95%置信区间：95%-99%），无显著异质性（I = 0.0%，P = 0.84），26 项报道临床成功率的研究汇总后的临床成功率为 69%（95%置信区间：58%-79%），存在显著异质性（I = 81.7%，P < 0.001）。32 项研究的总体并发症发生率汇总后为 28%（95%置信区间：20%-37%），存在显著异质性（I = 79.3%，P < 0.001）。
在阻塞性直肠或直肠乙状结肠肿瘤中使用直肠支架似乎在技术上是可行的。但高的技术成功率并不总是转化为临床成功率。该方法与相当高的并发症发生率相关。需要进行随机对照试验来比较直肠支架置入术与手术的结局。
