Management of acute malignant large-bowel obstruction with self-expanding metal stent.
OBJECTIVE
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 August 2009, 93 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum.


RESULTS
In 66 patients, the stents were placed for palliation; whereas, in 27 patients they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 86) of the patients, with a clinical success rate of 86% (n = 80). Three perforations occurred during stent placement, two were treated by an emergency Hartmann operation, and one by a colostomy. In the intention to treat by stent, the peri-interventional mortality was 6.5% (6/93). Stent migration was reported in three cases (3%), and stent obstruction occurred in 11 cases (12%). Of the 24 patients with stents successfully placed as a bridge to surgery, 22 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.
Branger
Frederic
F
Department of Visceral Surgery, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, Angers, 49100, France.
Thibaudeau
Emilie
E
Mucci-Hennekinne
Stéphanie
S
Métivier-Cesbron
Elodie
E
Vychnevskaia
Karina
K
Hamy
Antoine
A
Arnaud
Jean-Pierre
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011300:Preoperative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*