Department of General Surgery, Hospital Muri, Muri, Switzerland.
Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
Langenbecks Arch Surg. 2023 Jul 5;408(1):265. doi: 10.1007/s00423-023-02979-1.
Emergency resection is common for malignant right-sided obstructive colon cancer. As there is evidence showing a potential benefit of self-expandable metal stents as a bridge to surgery, a new debate has been initiated.
The aim of this study was to compare self-expandable metal stents with emergency resection in right-sided obstructive colon cancer.
A systematic search was conducted accessing Medline/PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews.
Studies reporting either emergency surgery or stent placement in right-sided obstructive colon cancer were included.
Stent or emergency resection in right-sided obstructive colon cancer.
Morbidity rate, mortality rate, stoma rate, laparoscopic resection rate, anastomotic insufficiency rate, success rate of stent.
A total of 6343 patients from 16 publications were analyzed. The stent success rate was 0.92 (95% CI, 0.87 to 0.95) with perforation of 0.03 (95% CI, 0.01 to 0.06). Emergency resection was performed laparoscopically at a rate of 0.15 (95% CI, 0.09 to 0.24). Primary anastomosis rate in emergency resection was 0.95 (95% CI, 0.91 to 0.97) with an anastomotic insufficiency rate of 0.07 (95% CI, 0.04 to 0.11). The mortality rate after emergency resection was 0.05 (95% CI, 0.02 to 0.09). Primary anastomosis and anastomotic insufficiency rate were similar between the two groups (RR: 1.02; 95% CI, 0.95 to 1.1; p = 0.56 and RR: 0.53; 95% CI, 0.14 to 1.93; p = 0.33). The mortality rate in emergency resection was higher compared to stent (RR: 0.51, 95% CI 0.30 to 10.89, p = 0.016).
No randomized controlled trials are available.
Stent is a safe and successful alternative to emergency resection and may increase the rate of minimally invasive surgery. Emergency resection, however, remains safe and did not result in higher rate of anastomotic insufficiency. Further high-quality comparative studies are warranted to assess long-term outcomes.
恶性右半结肠癌常需急诊切除。有证据表明自膨式金属支架作为桥接手术具有潜在益处，因此引发了新的争论。
本研究旨在比较自膨式金属支架与急诊切除术在右半结肠癌中的应用。
系统检索了 Medline/PubMed、Scopus、Embase 和 Cochrane 系统评价数据库。
纳入报告右半结肠癌急诊手术或支架置入的研究。
右半结肠癌中支架或急诊切除术。
发病率、死亡率、造口率、腹腔镜切除率、吻合口不足率、支架成功率。
共纳入 16 项研究中的 6343 例患者。支架成功率为 0.92（95%CI，0.87 至 0.95），穿孔率为 0.03（95%CI，0.01 至 0.06）。急诊切除手术中腹腔镜切除率为 0.15（95%CI，0.09 至 0.24）。急诊切除的一期吻合率为 0.95（95%CI，0.91 至 0.97），吻合口不足率为 0.07（95%CI，0.04 至 0.11）。急诊切除术后死亡率为 0.05（95%CI，0.02 至 0.09）。两组的死亡率和吻合口不足率相似（RR：1.02；95%CI，0.95 至 1.1；p=0.56 和 RR：0.53；95%CI，0.14 至 1.93；p=0.33）。与支架相比，急诊切除的死亡率更高（RR：0.51，95%CI，0.30 至 10.89，p=0.016）。
没有随机对照试验。
支架是一种安全有效的急诊切除替代方法，可能会增加微创手术的比例。然而，急诊切除仍然是安全的，并不会导致更高的吻合口不足发生率。需要进一步进行高质量的比较研究来评估长期结局。
