Evidence-based analysis of self-expanding metallic stent as a bridge to surgery versus emergency surgery for colon cancer

In the meta-analysis by Zhang et al. there was no significant difference in long-term survival rate, similar to Huang's findings (13 ,16). [...]they found a significantly higher primary anastomosis rate and lower complication rate for the SEMS bridge to surgery group versus the emergency surgery group. Discussion SEMS has been considered to be a promising strategy in emergency surgery since it theoretically combines the advantages of two-stage surgery (preparation for elective surgery correcting any patient's acute clinical derangements and at the same time treating the obstruction) with one-stage surgery (a single surgical procedure and no stoma). [...]SEMS could prevent some potential risks associated with the surgical approach (mortality, morbidity, length of hospital stay and economic impact) (15). [...]the precise role of SEMS as a bridge to surgery is still a matter of debate since there are heterogenous and conflicting data (even among the aforementioned meta-analyses) with regard to complications and outcome. [...]when this approach has been tested via RCTs, the majority of trials have been stopped prematurely for safety concerns (high morbidity on the SEMS arm) (11-12 ,15). [...]expertise could be relevant also in terms of outcome (i.e., a possible perforation related to poor/limited expertise in SEMS could potentially influence the outcome).