{"title":"晚期梗阻性结直肠癌的姑息手术：系统回顾和荟萃分析。","authors":"Bingqing Ma, Tianxing Ren, Chengjun Cai, Biao Chen, Jinxiang Zhang","doi":"10.1007/s00384-024-04724-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment.</p><p><strong>Methods: </strong>PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B).</p><p><strong>Results: </strong>Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate.</p><p><strong>Conclusion: </strong>Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420309/pdf/","citationCount":"0","resultStr":"{\"title\":\"Palliative procedures for advanced obstructive colorectal cancer: a systematic review and meta-analysis.\",\"authors\":\"Bingqing Ma, Tianxing Ren, Chengjun Cai, Biao Chen, Jinxiang Zhang\",\"doi\":\"10.1007/s00384-024-04724-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment.</p><p><strong>Methods: </strong>PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B).</p><p><strong>Results: </strong>Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate.</p><p><strong>Conclusion: </strong>Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment.</p>\",\"PeriodicalId\":13789,\"journal\":{\"name\":\"International Journal of Colorectal Disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420309/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Colorectal Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00384-024-04724-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00384-024-04724-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：晚期梗阻性结直肠癌（AOCC）给外科手术带来了挑战。必须考虑缓解症状、生活质量和生存时间。本研究比较了姑息性自膨胀金属支架（SEMS）和手术的预后效果，为AOCC的治疗提供见解：方法：在PubMed、Web of Science、MEDLINE和Cochrane图书馆检索符合纳入标准的研究。采用荟萃分析方法，比较了接受SEMS支架治疗的患者和接受手术治疗的患者的术后并发症、存活率和其他预后指标。通过网络荟萃分析比较了SEMS、原发肿瘤切除术（PTR）和造口/分流术（S/B）的预后：结果：共选取了 21 项研究（1754 名患者）。与手术相比，SEMS临床成功的几率比（OR）为0.32（95%置信区间[CI] 0.15，0.65）。早期和晚期并发症的OR值分别为0.34（95% CI 0.19，0.59）和2.30（95% CI 1.22，4.36）。30天死亡率和造口形成的OR值分别为0.65（95% CI 0.42，1.01）和0.11（95% CI 0.05，0.22）。住院时间的标准化平均差异为-2.08（95% CI - 3.56, 0.59）。总生存期的危险比为1.24（95% CI 1.08，1.42）。网络荟萃分析显示，SEMS的早期并发症发生率和造口形成率最低，住院时间最短。PTR 临床成功率排名第一，晚期并发症发生率最低。S/B组的30天死亡率最低：结论：在 AOCC 的姑息治疗中，SEMS 早期并发症、造口形成和 30 天死亡率较低，住院时间较短。手术治疗的临床成功率和总生存率较高，晚期并发症发生率较低。在选择 AOCC 治疗方法时，应考虑患者的病情/偏好。
Palliative procedures for advanced obstructive colorectal cancer: a systematic review and meta-analysis.
Purpose: Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment.
Methods: PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B).
Results: Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate.
Conclusion: Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment.
期刊介绍：
The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies.
The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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