Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis

Background: The placement of a metallic stent as a bridge to surgery (SBTS) could represents an option for the treatment of left-sided malignant colonic obstruction in centres with adequate skills. Several meta-analyses demonstrated better short-term outcomes after SBTS when compared with emergency surgery (ES); however, some studies reported a higher local recurrence rate. The aim of the present review is to investigate the long-term outcomes of stent bridge to surgery as compared to ES. Methods: A systematic review was performed to retrieve studies comparing long-term oncologic outcomes of SBTS and ES. Local and overall recurrence rate, overall and disease-free survival were retrieved and results were expressed as risk ratios. Results: Seventeen studies and a total of 1,333 patients were included in the analysis. No significant differences were reported in recurrence rate [risk ratio (RR) = 1.11; 95% confidence interval (95% CI): 0.84-1.47, P=0.47], 3-year mortality (RR = 0.90; 95% CI: 0.73-1.12, P=0.34) and 5-year mortality (RR = 1.00; 95% CI: 0.82-1.22, P= 0.99). There were no differences among randomized and observational studies. Conclusions: SBTS has similar long-term oncologic outcomes to ES and in centres with appropriate skill should be considered the best treatment option for left-sided malignant colonic obstructions.