Authors' objectives:

The objective of this review was to assess the safety and efficacy of self-expanding metallic stents (SEMS) for relieving malignant colorectal obstruction compared with surgical techniques, on the basis of a systematic assessment of the literature.

Authors' results and conclusions: A total of 15 comparative studies and 73 case series were identified for inclusion in this review. There were nine studies comparing SEMS to surgery (of which two were randomised controlled trials), three studies comparing elective surgery after decompression with SEMS to emergency surgery and two studies comparing covered and uncovered stents. The review was limited by the quality and quantity of the available evidence. Many of the included studies suffered from a lack of methodological rigour, which made assessing the validity of the data difficult. Not all studies reported all outcomes for different patient populations, further reducing the size of the evidence base. However, despite a poor quality evidence base, the available data suggested that SEMS placement was safe and effective in overcoming left-sided malignant colorectal obstructions, regardless of the indication for stent placement or underlying disease. Additionally, SEMS placement had positive outcomes when compared to surgery, including overall shorter hospital stays and a lower rate of serious adverse events. Post-operative mortality appeared comparable between the two 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. However, the small sample sizes of the included studies limited the validity of these findings.

Authors' recommendations: On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the safety and efficacy of self-expanding metallic stents: Classifications Evidence rating: The evidence base in this review is rated as poor. Safety: The safety of SEMS placement compared to surgery cannot be determined from this evidence base. However, considered in isolation, the evidence included in this review (primarily from case series and case reports) suggests that SEMS placement is a safe procedure for relieving left-sided colorectal obstructions. Efficacy: The efficacy of SEMS placement compared to surgery cannot be determined from this evidence base. However, considered in isolation, the evidence included in this review (primarily from case series and case reports) suggests that SEMS placement is an effective procedure for relieving left-sided colorectal obstructions, with high levels of technical and clinical success. Recommendations Current trials in progress may assist in further defining the clinical role of SEMS placement for the treatment of malignant colorectal obstructions, particularly those that evaluate patient-related outcomes. Additional comparative studies would increase the certainty of the conclusions that can be drawn.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/Content/NavigationMenu/Research/ASERNIPS/default .htm

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical