Abstract
Purpose
This study aims to evaluate the role of colonic stenting as a bridge to surgery in acutely obstructed left-sided colon cancer.
Methods
Patients with acute left-sided malignant colonic obstruction with no evidence of peritonitis were recruited. After informed consent, patients were randomized to colonic stenting followed by elective surgery or immediate emergency surgery. Patients who had successful colonic stenting underwent elective surgery 1 to 2 weeks later, while the other group had emergency surgery. Patients in whom stenting was unsuccessful also underwent emergency surgery.
Results
Twenty patients were randomized to stenting and 19 to emergency surgery. Fourteen patients (70%) had successful stenting and underwent elective surgery at a median of 10 days later; the rest underwent emergency surgery. Technical stent failure occurred in five patients (25%). One patient failed to decompress after successful stent deployment. All patients underwent definitive colonic resection with primary anastomosis. Two of 20 patients in the stenting group required defunctioning stomas compared to 6 of 19 in emergency surgery group, p = 0.127. Overall complication rate was 35% versus 58% (p = 0.152) and mortality was 0% versus 16% (p = 0.106) in the stenting group and emergency surgery group, respectively. Postoperatively, the stenting group was discharged from hospital earlier (median of 6 versus 8 days, p = 0.028) than the emergency surgery group.
Conclusion
Colonic stenting followed by interval elective surgery may be safer, with a trend towards lower morbidity and mortality when compared with the current practice of emergency surgery for left-sided malignant colonic obstruction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
National Registry of Diseases Office (2008) Singapore Cancer Registry interim report—trends in cancer incidence in Singapore 2002–2006. National Registry of Diseases Office, Singapore
Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81(9):1270–1276
Smith JJ, Cornish J, Tekkis P, Thompson MR (2007) The National Bowel Cancer Audit Project 2007: quality improvement and open reporting. Association of Coloproctology of Great Britain and Ireland, London
Hennekinne-Mucci S, Tuech JJ, Brehant O, Lermite E, Bergamaschi R, Pessaux P, Arnaud JP (2006) Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 21(6):538–541. doi:10.1007/s00384-005-0048-7
Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45(3):401–406
Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 Suppl):S44–S49
Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89(9):1096–1102
Lim JF, Tang CL, Seow-Choen F, Heah SM (2005) Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 48(2):205–209
Nyam DC, Leong AF, Ho YH, Seow-Choen F (1996) Comparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas. Dis Colon Rectum 39(9):1000–1003
Nyam DC, Seow-Choen F, Leong AF, Ho YH (1996) Colonic decompression without on-table irrigation for obstructing left-sided colorectal tumours. Br J Surg 83(6):786–787
Poon RT, Law WL, Chu KW, Wong J (1998) Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 85(11):1539–1542
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99(10):2051–2057
Osman HS, Rashid HI, Sathananthan N, Parker MC (2000) The cost effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction. Colorectal Dis 2(4):233–237
Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL (1998) Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology 206(1):199–204
Kam MH, Seow-Choen F, Peng XH, Eu KW, Tang CL, Heah SM, Ooi BS (2004) Minilaparotomy left iliac fossa skin crease incision vs. midline incision for left-sided colorectal cancer. Tech Coloproctol 8(2):85–88
Bethge N, Sommer A, Gross U, von Kleist D, Vakil N (1996) Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc 43(6):596–602
Chung TS, Lim SB, Sohn DK, Hong CW, Han KS, Choi HS, Jeong SY (2008) Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallic stent for obstructive left colorectal cancer. World J Surg 32(10):2275–2280
Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246(1):24–30
Author information
Authors and Affiliations
Corresponding author
Additional information
Category of paper
Randomized controlled trial.
Rights and permissions
About this article
Cite this article
Ho, KS., Quah, HM., Lim, JF. et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis 27, 355–362 (2012). https://doi.org/10.1007/s00384-011-1331-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1331-4