Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of...

Area of Science:

• Colorectal surgery
• Surgical oncology
• Gastroenterology

Background:

• Optimal management for malignant left-sided colonic obstruction is debated.
• Emergency resection is standard, but stenting or diverting stomas offer alternatives.
• Oncological outcomes and short-term benefits of stenting require evaluation.

Purpose of the Study:

• To systematically review and compare emergency resection, self-expanding metallic stenting (SEMS), and decompressing stomas.
• To evaluate oncologic efficacy, morbidity, and surgical outcomes for left-sided colonic obstruction.

Main Methods:

• Systematic review of PubMed, Embase, Cochrane Library, and Google Scholar (up to August 2023).
• Bayesian network meta-analysis of randomized controlled trials and propensity score-matched studies.
• Comparison of outcomes including morbidity, stoma rates, and survival.

Main Results:

• SEMS and decompressing stomas significantly reduced permanent stoma rates compared to emergency resection.
• SEMS use was associated with higher rates of minimally invasive surgery, increased primary anastomosis, and lower overall morbidity.
• No significant differences were observed in disease-free or overall survival rates between the strategies.

Conclusions:

• Bridge-to-surgery strategies (SEMS or stomas) are safe and effective for malignant left-sided colonic obstruction.
• These approaches may improve surgical outcomes and reduce complications compared to immediate resection.
• Further research is needed to compare SEMS and diverting stomas directly.