Management of acute malignant large-bowel obstruction with self-expanding metal stent.
BACKGROUND
Colorectal stents are being used for palliation and as a "bridge to surgery" in obstructing colorectal carcinoma. The purpose of this study was to review our experience with self-expanding metal stents (SEMS) as the initial interventional approach in the management of acute malignant large bowel obstruction.


METHODS
Between February 2002 and May 2006, 67 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum.


RESULTS
In 55 patients, the stents were placed for palliation, whereas in 12 they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 62), with a clinical success rate of 88% (n = 59). Two perforations that occurred during stent placement we retreated by an emergency Hartmann operation. In intention-to-treat by stent, the peri-interventional mortality was 6% (4/67). Stent migration was reported in 3 cases (5%), and stent obstruction occurred in 8 cases (13.5%). Of the nine patients with stents successfully placed as a bridge to surgery, all underwent elective single-stage operations with no death or anastomotic complication.


CONCLUSIONS
Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy.
Mucci-Hennekinne
S
S
Department of Visceral Surgery, CHU-Angers, 4 rue Larrey, Angers-49100, France.
Kervegant
A G
AG
Regenet
N
N
Beaulieu
A
A
Barbieux
J P
JP
Dehni
N
N
Casa
C
C
Arnaud
J P
JP
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000150:complications* / Q000473:pathology; D004638:Emergency Treatment / Q000379:methods; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome