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- Title
Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis.
- Authors
McKechnie, Tyler; Springer, Jeremy E.; Cloutier, Zacharie; Archer, Victoria; Alavi, Karim; Doumouras, Aristithes; Hong, Dennis; Eskicioglu, Cagla
- Abstract
Background: Several management options exist for colonic decompression in the setting of malignant large bowel obstruction, including oncologic resection, surgical diversion, and SEMS as a bridge-to-surgery. Consensus has yet to be reached on optimal treatment pathways. The aim of the present study was to perform a network meta-analysis comparing short-term postoperative morbidity and long-term oncologic outcomes between oncologic resection, surgical diversion, and self-expanding metal stents (SEMS) in left-sided malignant colorectal obstruction with curative intent. Methods: Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared two or more of the following in patients presenting with curative left-sided malignant colorectal obstruction: (1) emergent oncologic resection; (2) surgical diversion; and/or (3) SEMS. The primary outcome was overall 90-day postoperative morbidity. Pairwise meta-analyses were performed with inverse variance random effects. Random-effect Bayesian network meta-analysis was performed. Results: From 1277 citations, 53 studies with 9493 patients undergoing urgent oncologic resection, 1273 patients undergoing surgical diversion, and 2548 patients undergoing SEMS were included. Network meta-analysis demonstrated a significant improvement in 90-day postoperative morbidity in patients undergoing SEMS compared to urgent oncologic resection (OR0.34, 95%CrI0.01–0.98). Insufficient RCT data pertaining to overall survival (OS) precluded network meta-analysis. Pairwise meta-analysis demonstrated decreased five-year OS for patients undergoing urgent oncologic resection compared to surgical diversion (OR0.44, 95%CI0.28–0.71, p < 0.01). Conclusions: Bridge-to-surgery interventions may offer short- and long-term benefits compared to urgent oncologic resection for malignant colorectal obstruction and should be increasingly considered in this patient population. Further prospective study comparing surgical diversion and SEMS is needed.
- Subjects
LARGE intestine; BAYESIAN analysis; BOWEL obstructions; OVERALL survival; SURGICAL excision
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2023, Vol 37, Issue 6, p4159
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-023-09929-4