Colorectal stenting: an effective therapy for preoperative and palliative treatment.
OBJECTIVE
To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction.


METHODS
Sixty-seven consecutive patients (mean age 67.3 years, range 25-93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance.


RESULTS
Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2-22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10-285 days).


CONCLUSIONS
Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.
Jost
Rahel S
RS
Department of Surgery, Kantonsspital Winterthur, Brauersstrasse 15, 8401 Winterthur, Switzerland. raheljost@dplanet.ch
Jost
Res
R
Schoch
Erich
E
Brunner
Brigit
B
Decurtins
Marco
M
Zollikofer
Christoph L
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003106:Colon / Q000473:pathology; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D011474:Prosthesis Design; D012007:Rectum / Q000473:pathology; D019233:Retreatment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome