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Self-expanding Metallic Stents for Relieving Malignant Colorectal Obstruction: A Systematic Review

Watt, Amber M. BmedSc*; Faragher, Ian G. FRACS; Griffin, Tabatha T. PhD*; Rieger, Nicholas A. MB, MS, FRACS‡§; Maddern, Guy J. PhD, FRACS*‡∥

doi: 10.1097/01.sla.0000261124.72687.72
Review

Objective: To assess the safety and efficacy of self-expanding metallic stents (SEMS) placement for the relief of malignant colorectal obstruction in comparison to surgical procedures through a systematic review of the literature.

Summary Background Data: Conventional therapies for relieving colorectal obstructions caused by cancer have high rates of morbidity and mortality, particularly when performed under emergency conditions, and palliative procedures resulting in colostomy creation can be a burden for patients and caregivers.

Methods: A systematic search strategy was used to retrieve relevant studies. Inclusion of papers was established through application of a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Eighty-eight articles, 15 of which were comparative, formed the evidence base for this review.

Results: Little high-level evidence was available. However, the data suggested that SEMS placement was safe and effective in overcoming left-sided malignant colorectal obstructions, regardless of the indication for stent placement or the etiology of the obstruction. Additionally, SEMS placement had positive outcomes when compared with surgery, including overall shorter hospital stays, and a lower rate of serious adverse events. Postoperative mortality appeared comparable between the 2 interventions. Combining SEMS placement with elective surgery also appeared safer and more effective than emergency surgery, with higher rates of primary anastomosis, lower rates of colostomy, shorter hospital stays, and lower overall complication rates.

Conclusions: Stenting appears to be a safe and effective addition to the armamentarium of treatment options for colorectal obstructions. However, the small sample sizes of the included studies limited the validity of the findings of this review. The results of additional comparative studies currently being undertaken will add to the certainty of the conclusions that can be drawn.

This article reviews the safety and efficacy of self-expanding metallic stents (SEMS)for the treatment of malignant colorectal obstruction, both as a stand-alone procedure and in comparison to surgical procedures. Results from the included studies indicate that SEMS are safe and effective and suggest advantages for SEMS over surgery. However, more evidence of a higher quality is required before definitive conclusions can be reached.

From the *ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia; †Western Hospital, Footscray, Victoria, Australia; ‡Department of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia; §Colorectal Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; and ∥Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia.

The ASERNIP-S project is funded by the Australian Government Department of Health and Ageing.

The full Australian Safety and Efficacy Register of New Interventional Procedures–Surgical (ASERNIP-S) systematic review of this procedure with data extraction tables can be found at the ASERNIP-S Web site: www.surgeons.org/asernip-s/.

Reprints: Guy J. Maddern, PhD, FRACS, PO Box 553, Stepney SA 5069, Australia. E-mail: asernips@surgeons.org.

© 2007 Lippincott Williams & Wilkins, Inc.