Short-term outcomes of stents in obstructive rectal cancer: A systematic review and meta-analysis
Nora H Trabulsi1, Hajar M Halawani2, Esraa A Alshahrani2, Rawan M Alamoudi2, Sama K Jambi2, Nouf Y Akeel1, Ali H Farsi1, Mohammed O Nassif1, Ali A Samkari1, Abdulaziz M Saleem1, Nadim H Malibary1, Mohammad M Abbas1, Luca Gianotti3, Antonietta Lamazza4, Jin Young Yoon5, Nada J Farsi6
1 Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Surgery, School of Medicine and Surgery, University of Milano-Bicocca, and San Gerardo Hospital, Monza, Italy
4 Department Pietro Valdoni-Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
5 Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
6 Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
Dr. Nora H Trabulsi
Department of Surgery, Faculty of Medicine, King Abdulaziz University, PO Box 21589, Jeddah 80200
Source of Support: None, Conflict of Interest: None
Background: With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients.
Methods: We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates.
Results: We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I2 = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I2 = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I2 = 79.3%, P < 0.001).
Conclusion: The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.