Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates.
OBJECTIVE
At present there are not enough studies that demonstrate the usefulness of self-expandable stents in patients with left-sided malignant colon and rectal obstruction. We evaluated primary anastomosis and morbidity rates obtained with this method in comparison with the results of the emergency surgical treatment.


METHODS
From February 1994 to November 1999, 72 consecutive patients with left-sided malignant colorectal obstruction were enrolled. Forty-three patients were assigned to the study group (preoperative stent and elective surgical treatment or palliative stent, depending on the assessment of the stage of the tumor) and 29 to the control group (emergency surgical treatment). The resection was not indicated in 18 cases in the study group (after preoperative staging in 17 and intraoperative staging in 1) and in 3 cases in the control group.


RESULTS
In the study group, the obstruction was relieved in 41 cases (95 percent) after the stent placement. Of 26 patients who underwent surgical treatment, a primary anastomosis was possible in 22 (84.6 vs. 41.4 percent in the control group, P = 0.0025), with lower need for a colostomy (15.4 vs. 58.6 percent in the control group). The anastomotic failure rate was similar and the reintervention rate was lower (0 vs. 17 percent, P = 0.014). The total stay (14.23 vs. 18.52 days; P = 0.047), the intensive care unit stay (0.3 vs. 2.9 days; P = 0.015), and the number of patients with severe complications (11.6 vs. 41.2 percent; P = 0.008) were significantly lower in the study group.


CONCLUSIONS
In our patients with left-sided malignant colon and rectal obstruction, placement of a preoperative stent prevented 17 (94 percent) of 18 of unnecessary operations and a large number of colostomies after elective surgery. These results were obtained with a lower severe complication rate as well as a shorter hospital stay.
Martinez-Santos
Cristina
C
Department of General Surgery, Getafe University Hospital, Madrid, Spain.
Lobato
Rosa F
RF
Fradejas
José Manuel
JM
Pinto
Isabel
I
Ortega-Deballón
Pablo
P
Moreno-Azcoita
Mariano
M
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004638:Emergency Treatment / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D015607:Stents; D015996:Survival Rate