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Abstract：
Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches.
We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data.
We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = - 4.47, 95% CI - 6.26, - 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = - 37.67, 95% CI - 62.73, - 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05).
SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registration CRD42022365951 .
We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data.
We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = - 4.47, 95% CI - 6.26, - 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = - 37.67, 95% CI - 62.73, - 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05).
SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registration CRD42022365951 .
摘要：
背景：使用自膨胀金属支架（SEMS）和减压管（DT）作为桥接手术（BTS）治疗可以避免对结直肠癌引起的阻塞患者进行紧急手术。本研究旨在评估两种方法的有效性和安全性。
方法：我们从PubMed系统检索了2000年1月1日至2023年5月30日的文献，Embase,WebofScience,SinoMed,万方数据,中国国家知识基础设施，和Cochrane中央临床试验注册数据库。选择SEMS与DT作为BTS在结直肠癌梗阻中的随机对照试验（RCT）或队列研究。使用Cochrane偏差风险工具版本2和非随机干预研究中的偏差风险评估RCT和队列研究的偏差风险。使用分级推荐评估确定证据的确定性。赔率比(OR)，平均差(MD)，和95%置信区间(95%CI)用于分析测量数据。
结果：我们纳入了8项随机对照试验和18项队列研究，涉及2,061名患者（SEMS，1,044；DT，1,017）。合并RCT和队列数据表明，SEMS组的临床成功率明显高于DT组（OR=1.99，95％CI1.04，3.81，P=0.04）。技术成功率无显著差异(OR=1.29,95%CI0.56,2.96,P=0.55)。SEMS术后住院时间较短(MD=-4.47,95%CI-6.26,-2.69,P<0.00001),手术相关腹痛发生率较低(OR=0.16,95%CI0.05,0.50,P=0.002),术中出血(MD=-37.67,95%CI-62.73,-12.60,P=0.003),造口创建(OR=0.41,95%CI0.23,0.73,P=0.002)和肿瘤远期复发率比DT(OR=0.47,95%CI0.22,0.99,P=0.05)。
结论：SEMS和DT作为BTS都是安全的，可以避免结直肠癌梗阻患者的急诊手术。SEMS是优选的，因为更高的临床成功率，手术相关腹痛的发生率较低，术中出血,造口的创造，和长期肿瘤复发，以及更短的术后住院时间。试用注册CRD42022365951。
方法：我们从PubMed系统检索了2000年1月1日至2023年5月30日的文献，Embase,WebofScience,SinoMed,万方数据,中国国家知识基础设施，和Cochrane中央临床试验注册数据库。选择SEMS与DT作为BTS在结直肠癌梗阻中的随机对照试验（RCT）或队列研究。使用Cochrane偏差风险工具版本2和非随机干预研究中的偏差风险评估RCT和队列研究的偏差风险。使用分级推荐评估确定证据的确定性。赔率比(OR)，平均差(MD)，和95%置信区间(95%CI)用于分析测量数据。
结果：我们纳入了8项随机对照试验和18项队列研究，涉及2,061名患者（SEMS，1,044；DT，1,017）。合并RCT和队列数据表明，SEMS组的临床成功率明显高于DT组（OR=1.99，95％CI1.04，3.81，P=0.04）。技术成功率无显著差异(OR=1.29,95%CI0.56,2.96,P=0.55)。SEMS术后住院时间较短(MD=-4.47,95%CI-6.26,-2.69,P<0.00001),手术相关腹痛发生率较低(OR=0.16,95%CI0.05,0.50,P=0.002),术中出血(MD=-37.67,95%CI-62.73,-12.60,P=0.003),造口创建(OR=0.41,95%CI0.23,0.73,P=0.002)和肿瘤远期复发率比DT(OR=0.47,95%CI0.22,0.99,P=0.05)。
结论：SEMS和DT作为BTS都是安全的，可以避免结直肠癌梗阻患者的急诊手术。SEMS是优选的，因为更高的临床成功率，手术相关腹痛的发生率较低，术中出血,造口的创造，和长期肿瘤复发，以及更短的术后住院时间。试用注册CRD42022365951。
