Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial.
OBJECTIVE
This study aims to evaluate the role of colonic stenting as a bridge to surgery in acutely obstructed left-sided colon cancer.


METHODS
Patients with acute left-sided malignant colonic obstruction with no evidence of peritonitis were recruited. After informed consent, patients were randomized to colonic stenting followed by elective surgery or immediate emergency surgery. Patients who had successful colonic stenting underwent elective surgery 1 to 2 weeks later, while the other group had emergency surgery. Patients in whom stenting was unsuccessful also underwent emergency surgery.


RESULTS
Twenty patients were randomized to stenting and 19 to emergency surgery. Fourteen patients (70%) had successful stenting and underwent elective surgery at a median of 10 days later; the rest underwent emergency surgery. Technical stent failure occurred in five patients (25%). One patient failed to decompress after successful stent deployment. All patients underwent definitive colonic resection with primary anastomosis. Two of 20 patients in the stenting group required defunctioning stomas compared to 6 of 19 in emergency surgery group, p = 0.127. Overall complication rate was 35% versus 58% (p = 0.152) and mortality was 0% versus 16% (p = 0.106) in the stenting group and emergency surgery group, respectively. Postoperatively, the stenting group was discharged from hospital earlier (median of 6 versus 8 days, p = 0.028) than the emergency surgery group.


CONCLUSIONS
Colonic stenting followed by interval elective surgery may be safer, with a trend towards lower morbidity and mortality when compared with the current practice of emergency surgery for left-sided malignant colonic obstruction.
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore. Drho@hokoksuncolorectal.com.sg
Kok-Sun
KS
Ho
Hak-Mien
HM
Quah
Jit-Fong
JF
Lim
Choong-Leong
CL
Tang
Kong-Weng
KW
Eu
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000191:economics; D004630:Emergencies / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome