Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: Meta-analysis with systematic review of the literature

Table 1 Characteristics of included studies

Ref.	Format	Country	Type of study	CS/ES	Etiology of obstruction	Site of obstruction	Colonic stent	Emergency surgery	Elective surgicaltreatment
van Hooft et al[16], 2008	FT	Netherlands	MLC	11/10	OLCC	RS: 16 DC: 6	Endoscopic-fluoroscopic placement of Boston Scientific WallFlex	Open or laparoscopic palliative resection or fecal diversion	None
Cheung et al[18], 2009	FT	China	MNC	24/24	OLCC	Between the splenic flexure and the RSJ	Endoscopic-fluoroscopic placement of Boston Scientific Wallstent	Hartmann’s procedure; primary anastomosis after subtotal or total colectomy or segmental colectomy with on-table lavage according to the operators’ judgment	Elective laparoscopic-assisted colectomy
Alcántara et al[22], 2011	FT	Spain	MNC	15/13	OLCC	SF: 6 DC: 3 Sigma: 15 RSJ: 3 Rectum sup: 1	NA	Retrowash (Intermark Medical Interventions Ltd, Bromley, Kent, United Kingdom), a retrograde variation of the traditional anterograde lavage	Colectomy with PA: 14 HP: 1
Pirlet et al[20], 2011	FT	France	MLC	35/32	OLCC: 60 benign Stenosis: 3 NA: 7	RSJ: 15 Sigma: 33 DC: 8 SF: 3 NA: 1 (10 drop-out)	Endoscopic-fluoroscopic placement of Bard nitinol uncovered self-expanding stents (Voisins le Bretonneux, France)	One-stage procedure: 14 Two-stage surgery: 8 Three-stage surgery: 2	Colectomy with PA
van Hooft et al[15,16], 2011	FT	Netherlands	MLC	47/51	NA	NA	Endoscopic-fluoroscopic placement of Wallstent and WallFlex colonic stents (Boston Scientific, Natick, MA, United States)	Treatment according to conventional standards	NA
Cheung et al[13], 2012	FT	South Korea	MLC	58/62	OLCC	Ascending colon: 10 Transverse: 9 DC: 14 Sigma: 65 Rectum: 25	Taewoong D-type uncovered stent; Boston scientific WallFlex stent fluoroscopy placement with through the scope or over the wire method		Palliative intent: 58 BTS: 65
Ghazal et al[19], 2012	FT	Egypt	MNC	30/30	OLCC	RSJ: 12-10 Sigma: 14-17 DC: 4-3	Endoscopic placement under fluoroscopic guidance	Total abdominal colectomy and ileorectal anastomosis by laparotomy	Left hemicolectomy or anterior resection
Tung et al[17], 2012	FT	China	MNC	24/24	OLCC	NA	Endoscopic-fluoroscopic placement of Boston Scientific Wallstent	NA	LR

BTS: Bridge to surgery; DC: Distending colon; FT: Full-text; HP: Hartmann’s procedure; LR: Laparoscopic resection; MLC: Multi-center study; MNC: Mono-centric study; NA: Not available; OLCC: Obstructive left-sided colon cancer; PA: Primary anastomosis; RSJ: Rectosigmoid junction; SF: Splenic flexure.