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Controversies of colonic stenting in obstructive left colorectal cancer: a critical analysis with meta-analysis and meta-regression

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Abstract

Purpose

After almost three decades since the first description of colonic stents, the controversies of its safe application continue to impede the readiness of adoption by clinicians for malignant left bowel obstruction. This review seeks to address some of the controversial aspects of stenting and its impact on surgical and oncological outcomes.

Methods

Medline, Embase, and CNKI were searched for articles employing SEMS for left colonic obstruction. Outcomes analyzed include success rates, complications, and long-term survival. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated.

Results

36 studies were included with 2002 patients across seven randomized controlled trials and 29 observational studies. High technical (92%) and clinical (82%) success rates, and low rates of complications, including perforation (5%), were found. Those with > 8% perforation rates had poorer technical success rates than those with ≤ 8%, but there were no significant differences in 90-day in-hospital mortality and three and 5-year overall and disease-free survival. A significant increase was found in technical (RR = 1.094; CI, 1.041–1.149; p < 0.001) and clinical (RR = 1.158; CI, 1.064–1.259; p = 0.001) success rates when the duration between stenting and surgery was ≥ 2 weeks compared to < 2 weeks, but there were no significant differences in perforation rates, 90-day in-hospital mortality, and long-term survival.

Conclusions

Colonic stenting is safe and effective with high success rates and low complication rates. However, outcomes of higher perforation rates and optimal timing from stent till surgery remain unclear, with only a few studies reporting on these outcomes, leaving areas for future research.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Vernicia Shu Qi Neo, Sneha Rajiv Jain, Jun Wei Yeo, Cheng Han Ng & Choon Seng Chong

  2. Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Tiffany Rui Xuan Gan & Choon Seng Chong

  3. Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia Level 5, Singapore, 169856, Singapore

    Emile Tan

  4. Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore

    Choon Seng Chong

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  2. Sneha Rajiv Jain
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  3. Jun Wei Yeo
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  4. Cheng Han Ng
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  5. Tiffany Rui Xuan Gan
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  6. Emile Tan
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  7. Choon Seng Chong
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Contributions

Vernicia Neo Shu Qi: literature search, data collection, analysis and interpretation, drafting the article, critical revision of article, and final approval.

Sneha Rajiv Jain: literature search, data collection, analysis and interpretation, drafting the article, critical revision of article, and final approval.

Yeo Jun Wei: literature search, data collection, analysis, and interpretation.

Ng Cheng Han: study conception, literature search, methodology, critical revision of article, and final approval.

Tiffany Gan Rui Xuan: data collection, drafting the article, and critical revision of article.

Emile Tan: critical revision of article and final approval.

Chong Choon Seng: study conception, methodology, data interpretation, critical revision of article, and final approval.

All authors have contributed to and agreed on the content of the manuscript.

Corresponding author

Correspondence to Choon Seng Chong.

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Neo, V.S.Q., Jain, S.R., Yeo, J.W. et al. Controversies of colonic stenting in obstructive left colorectal cancer: a critical analysis with meta-analysis and meta-regression. Int J Colorectal Dis 36, 689–700 (2021). https://doi.org/10.1007/s00384-021-03834-9

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