An evaluation of the effectiveness and safety of endoscopic colon stenting in the treatment of obstructive left colon cancer: a systematic review and meta-analysis.

OBJECTIVE

The objective of this study was to compare the long-term outcomes of colonic stenting in combination with elective surgery versus emergency surgery for the treatment of obstructive left colon cancer.

BACKGROUND

Obstructive left colon cancer often presents a clinical challenge due to the acute nature of the obstruction, which requires prompt intervention. Traditionally, emergency surgery has been the standard approach to manage such cases, but it carries a higher risk of complications and morbidity. Colonic stenting has emerged as an alternative to provide a bridge to elective surgery, potentially reducing the need for urgent surgical intervention and improving patient outcomes. However, the long-term efficacy and safety of stenting in conjunction with elective surgery compared to emergency surgery remain topics of ongoing research and debate.

METHODS

A comprehensive search of domestic and international databases was conducted up to June 2022 to identify clinical research publications on the use of colonic stenting in conjunction with elective and emergency surgeries for obstructive left colon cancer. After assessing the quality of the included literature and extracting the relevant outcome indicators, data analysis was performed using RevMan 5.3 software.

RESULTS

The analysis revealed statistically significant differences in the total and local recurrence rates between the experimental group (stenting combined with elective surgery) and the control group (emergency surgery) [OR = 1.83, 95%CI (1.35,2.48), P < 0.0001, I2 = 76%, Z = 3.93]. Total survival duration and disease-free survival tenure were also found to be statistically significant [OR = 2.40, 95%CI (1.63,3.55), P < 0.0001, I2 = 49%, Z = 4.41]. However, the complication rate did not show a statistically significant difference [OR = 1.12, 95%CI (0.81,1.55), P = 0.05, I2 = 90%, Z = 0.67].

CONCLUSION

Although our statistical analysis showed significant differences in recurrence rates and survival times between stenting and emergency surgery groups, the clinical significance of these differences must be weighed against the short-term benefits of the stenting approach. When considering the total clinical picture, including complication rates, quality of life factors, and the ability to perform more targeted elective procedures, colonic stenting combined with elective surgery remains a valuable option for obstructive left colon cancer. Further research is warranted to confirm these findings and to refine the selection criteria for patients who would benefit most from colonic stenting.