Abstract
Background
Self-expanding metallic stents (SEMS) are now regarded as a safe and effective treatment for an acute obstructing colorectal cancer. SEMS insertion is an invasive procedure that could potentially worsen prognosis. This study assessed the short-and long-term outcomes in patients stented for acute large bowel obstruction and in patients who underwent primary emergency surgery.
Methods
We retrospectively identified 19 patients who underwent SEMS insertion and 23 patients who had primary emergency surgery for left-sided large bowel obstruction as the first presentation of colorectal cancer.
Results
There were no significant differences between the 19 patients in the SEMS group and the 23 patients in the primary emergency surgery group in terms of demographics and tumour location and stage. Stent insertion was successful in 16 patients (84%). One patient died from a stent-related perforation and another had a stoma fashioned for stent migration. Stents were a definitive procedure in 2 patients with advanced disease and acted as a “bridge to surgery” in the remaining 12 patients. Compared to the primary surgery group, there was a trend towards a higher primary anastomosis rate in the SEMS group (p=0.08); there were no significant differences in length of hospital stay, 30-day mortality or complication rates between the groups. Long-term prognosis (estimated 3-year survival) did not differ significantly between the groups (p=0.54); this persisted when only curative resections were considered (p=0.80).
Conclusions
Preoperative stent insertion is a safe and effective treatment for large bowel obstruction, and may result in a higher primary anastomosis rate. Stent insertion does not seem to have a deleterious effect on prognosis.
Similar content being viewed by others
References
Papachristodoulou A, Zografos G, Markopoulos C et al (1993) Obstructive colonic cancer. J R Coll Surg Edinb 38:296–298
Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188
Association of Coloproctology of Great Britain and Ireland (2000) National audit of bowel obstruction due to colorectal cancer April 1998—March 1999. Association of Coloproctology of Great Britain and Ireland, London
Khot U, Wenk Lang A, Murali K, Parker MC (2002) Systematic review of the clinical evidence on colorectal self-expanding metal stents. Br J Surg 89:1096–1102
Tejero E, Mainar A, Fernandez L et al (1995) New procedure for relief of malignant obstruction of the left colon. Br J Surg 82:34–85
Saida Y, Sumiyama Y, Nagao J, Takase M (1996) Stent endoprosthesis for obstructing colorectal cancers. Dis Colon Rectum 39:552–355
Martinez-Santos C, Lobato RF, Fradejas JM et al (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 45:401–406
Saida Y, Sumiyama Y, Nagao J, Takase 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:S44–S49
Soonawalla Z, Thakur K, Boorman P et al (1998) Use of self expanding metallic stents in the management of obstruction of the sigmoid colon. AJR Am J Roentgenol 171:633–636
Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Harris GJC, Senagore AJ, Lavery IC, Fazio VW (2001) The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg 181:499–506
Balague C, Targarona EM, Sainz S et al (2004) Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Preliminary results. Dig Surg 21:282–286
Law WL, Choi HK, Lee YM, Chu KW (2004) Laparoscopic colectomy for obstructing sigmoid cancer with prior insertion of an expandable metallic stent. Surg Laparosc Endosc Percutan Tech 14:29–32
Multicentre colorectal stent trial. [www.crstrial.com]; Accessed 29 November 2007
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dastur, J.K., Forshaw, M.J., Modarai, B. et al. Comparison of short-and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol 12, 51–55 (2008). https://doi.org/10.1007/s10151-008-0399-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-008-0399-5