Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study.
BACKGROUND
Acute malignant colorectal obstruction (CRO) can be satisfactorily dealt by the placement of a self-expanding metallic stent (SEMS). The aim of this prospective study was to evaluate the rate of elective (planned) colectomy (EPC) in patients with CRO after SEMS placement as a bridge to surgery on an intention-to-treat (ITT) basis.


METHODS
From 2002 to 2007, 30 SEMS were placed as a bridge to surgery in 30 CRO patients (median age 73 +/- 12 years). The obstructing lesions were located in the right (n = 1), transverse (n = 1) or left colon (n = 24) or the upper third of the rectum (n = 4).


RESULTS
The SEMS was placed successfully in 25 (83%) patients. Five patients underwent Hartmann's procedure (n = 2) or a diverting colostomy (n = 3). The SEMS was functionally operational in 23 (92%) of the 25 patients. A diverting colostomy was avoided in 23 (77%) of the 30 patients (placement failure n = 5, clinical failure n = 2). There were no complications in 17 (80%) patients. On an ITT basis, 70% of the patients (21 out of 30) underwent an EPC.


CONCLUSIONS
On an ITT basis, SEMS placement in CRO patients enabled EPC in 70% of patients.
Brehant
O
O
Federation of Digestive Diseases, Amiens North Hospital, University of Picardy Jules Verne, Amiens Cedex 01, France.
Fuks
D
D
Bartoli
E
E
Yzet
T
T
Verhaeghe
P
P
Regimbeau
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents