[Extraordinary role of self-expanding metal stent (SEMS) in the malignant colorectal obstruction: different care in two cases].
The colorectal cancer presents with bowel obstruction in 10%-30% of patients. Established treatment of this evolutive condition, until 15 years ago, was emergency surgery. Primary resection with or without ileostomy, staged resection, Hartmann's procedure, or definitive colostomy are the therapeutical options. There is ongoing controversy on the best procedure to apply, because the choice depends on the patient's condition, age, electrolyte imbalances, nutritional status, obstructional grade, comorbidity and surgeon's attitude. However, the obstruction and the emergency operation add risk of complications and mortality instead of elective surgery. The efficacy of self-expanding metal stent to solve the obstruction had recently changed the management of malignant luminal obstruction: it is safe, effective, with very low mortality, low morbidity and also cheap. In the inoperable cases it represents the first line therapy avoiding the colostomy. In the operable patients, instead of two-step surgery, the SEMS had to be preferred because is a one-time and election surgery and avoid colostomy too, even if temporary. SEMS versus emergency primary surgery, without randomized and controlled study, allows a safer single-staged surgery. Finally it improves the quality of life avoiding colostomy, and reducing operative risk. We present two different use of SEMS: the palliation in inoperable patient and the "bridge to surgery" in critical obstructed patient.
Siquini
Walter
W
Istituto di Clinica Chirurgica, Dipartimento di Scienze Medico-Chirurgiche, Università Politecnica delle Marche, Ancona, w.siquini@univpm.it
Macarri
Giampiero
G
Freddara
Umberto
U
Stortoni
Pierpaolo
P
Ridolfo
Raffaella
R
Petrolati
Paolo
P
Fianchini
Aroldo
A
Landi
Edoardo
E
D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D010166:Palliative Care / Q000379:methods; D019919:Prosthesis Implantation; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome