Palliative procedures for advanced obstructive colorectal cancer: a systematic review and meta-analysis

Area of Science:

• Gastroenterology and Surgical Oncology
• Colorectal Cancer Treatment Strategies

Background:

• Advanced obstructive colorectal cancer (AOCC) poses significant surgical challenges.
• Treatment decisions for AOCC must balance symptom alleviation, quality of life, and survival.
• Palliative interventions are crucial for managing AOCC symptoms and improving patient outcomes.

Purpose of the Study:

• To compare the prognostic efficacies of palliative self-expanding metal stents (SEMSs) versus surgical interventions for AOCC.
• To provide evidence-based insights for optimizing AOCC treatment selection.
• To evaluate key outcomes including complications, survival rates, and quality of life.

Main Methods:

• A systematic literature search was conducted across PubMed, Web of Science, MEDLINE, and Cochrane Library.
• A meta-analysis approach was employed to compare outcomes between SEMS and surgical groups.
• Network meta-analysis was utilized to compare SEMS, primary tumor resection (PTR), and stoma/bypass (S/B) interventions.

Main Results:

• SEMSs demonstrated significantly lower rates of early complications (OR 0.34) and stoma formation (OR 0.11) compared to surgery.
• Surgery showed higher clinical success (OR 0.32 vs SEMS) and overall survival rates (HR 1.24).
• Primary tumor resection (PTR) led in clinical success and had fewer late complications, while stoma/bypass (S/B) had the lowest 30-day mortality.

Conclusions:

• SEMSs are associated with reduced early complications, stoma rates, and mortality, alongside shorter hospital stays for AOCC palliation.
• Surgical options, particularly PTR, offer superior clinical success and survival rates with fewer late complications.
• Treatment choice for AOCC should be individualized based on patient condition and preferences.