title: Self-expanding metallic stents as bridge to surgery in obstructing colorectal cancer.
abstract: BACKGROUND
  A self-expanding metallic stent (SEMS) may relieve intestinal obstruction to permit elective resection of colorectal cancer presenting as an emergency. There have been concerns regarding the oncological consequences of this strategy. This study evaluated outcomes in patients with potentially curable colorectal cancer treated with a SEMS as a bridge to surgery.
  
  
  METHODS
  This retrospective study included patients with obstructing colorectal cancer in whom a SEMS procedure was attempted between January 2004 and August 2007. Palliative SEMS procedures were excluded. Outcomes for SEMS insertion and subsequent surgery were recorded with a focus on survival.
  
  
  RESULTS
  SEMS insertion was attempted and achieved in 34 patients, of whom 30 were discharged after successful relief of obstruction. However, five patients needed acute surgery within 18 days owing to insufficient relief of obstruction (1), or tumour (3) or caecal (1) perforation, with one postoperative death. The remainder underwent elective surgery with no postoperative mortality. In all, 28 of 34 patients were stoma free after operation. The 3-year survival rate of all 34 patients was 74 (95 per cent confidence interval 53 to 86) per cent after a median follow-up of 33·7 months. A curative outcome was achieved in 30 patients.
  
  
  CONCLUSIONS
  Although associated with significant short-term problems, a SEMS can be useful in converting an emergency into an elective situation. No adverse oncological consequences were identified.
authors.affiliation: Department of Surgery P, Aarhus University Hospital THG, Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark. lene.h.iversen@dadlnet.dk
authors.forename: L H
authors.initials: LH
authors.lastname: Iversen
authors.forename: M
authors.initials: M
authors.lastname: Kratmann
authors.forename: M
authors.initials: M
authors.lastname: Bøje
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome