Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years' experience.
BACKGROUND
Since their introduction, selfextending metal stents (SEMS) have established themselves as an option in the treatment of obstructive colorectal cancer. Thanks to stenting, patients traditionally treated with emergency surgery can now be converted to scheduled surgery with mechanical preparation of the colon and primary anastomosis. Stenting represents a valid one-step surgical alternative for intestinal obstruction of the colon.


METHODS
We performed a prospective study of 95 patients (mean age, 68 years; range 48-94) with large bowel obstruction due to colorectal cancer treated with SEMS placed under fluoroscopic guidance, some as a bridge to surgery (group A) and others with palliative intent (group B). Computed tomography was performed for diagnostic purposes and to study the extent of disease.


RESULTS
Treatment was palliative in 28 cases (group B) and as a bridge to surgery in 67 (group A). The latter group underwent mechanical preparation of the colon and elective surgery. No patients died as a result of the procedure. In 90 cases (95%), treatment was effective and the obstruction resolved. Complications were 4 cases of perforation, 1 of tenesmus, 4 obstructions and 4 migrations. In 7 cases, a second stent was inserted to allow subsequent scheduled surgery.


CONCLUSIONS
Self-extending stents resolve colorectal cancer obstruction and allow optimal patient staging and scheduled surgical treatment. Stenting is also a useful option in advanced or irresectable tumors, avoiding the need for surgery and offering good palliation.
Coloproctology Unit, Sabadell Hospital, Parc Taulí S/N 08208, Sabadell Barcelona, Spain. malcantara09@vodafone.es
M
M
Alcantara
X
X
Serra
J
J
Bombardó
J
J
Falcó
J
J
Perandreu
I
I
Ayguavives
L
L
Mora
R
R
Hernando
S
S
Navarro
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012007:Rectum / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome