Background There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the prognosis of several treatment strategies for acute left malignant colonic obstruction.
Methods A systematic literature review and network meta-analysis were performed.
Results The network meta-analysis involved 48 articles, including 8 (Randomized controlled trials) RCTs and 40 non-RCTs.
Short-term results: Compared with emergency surgery (ES) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies.
Long-term results: The 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES.
Conclusion Different preoperative decompression strategies may improve the prognosis of patients with acute left malignant colon obstruction. Comprehensive literature research, we found that timely and effective relief of intestinal obstruction would bring a better prognosis. Therefore, CS-BTS, DS-BTS and TCT-BTS are better than ES. Compared with CS-BTS and DS-BTS, CS-BTS has the risk of re-obstruction and intestinal perforation, and the long-term prognosis is slightly worse than that of DS-BTS. Without considering the length of stay and cost, DS-BTS strategy is the best choice.