Seven studies (n=850; 536 underwent surgery and 314 underwent chemotherapy) were included in the review: four retrospective case series; two prospective case series; and one retrospective case-control study. Sample sizes ranged from 21 to 362 patients. Study quality ranged from 12 to 21.
The pooled proportion of patients who developed bowel obstruction after receiving initial treatment with chemotherapy was 13.9 per cent (95% CI: 9.6% to 18.8%; six studies). The pooled proportion of patients experiencing haemorrhage from the primary tumour was 3.0 per cent (95% CI: 0.95% to 6.0%; four studies). One of two studies reported the development of peritonitis or fistulae in 6.1 per cent of patients due to un-resected tumour.
The pooled proportion of patients developing major complications (obstruction, haemorrhage and sepsis) after surgery was 11.8 per cent (95% CI: 4.4% to 22.0%; four studies).
Two of six studies reported statistically significant differences in survival, with patients receiving chemotherapy reporting shorter median survival rates (8.2 and 9.0 months) compared with patients treated with surgery (14 and 16 months).