title: Short- and long-term outcomes of self-expanding metal stent placement as a bridge to surgery for acute left-sided colorectal cancer obstruction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the short- and long-term outcomes of self-expanding metal stent (SEMS) insertion as a bridge to surgery (BTS) in patients presenting with acute left-sided colorectal cancer obstruction (LCCO).
  
  
  METHODS
  All patients with acute LCCO who underwent endoscopic SEMS placement as a BTS between January 2005 and December 2010 were reviewed and included in the study.
  
  
  RESULTS
  Thirty-six patients (19M and 17F; mean age 68.5) were included. The most frequent location was the sigmoid colon (47.2%). Technical success was achieved in 91.6% and clinical success in 88.9%. Technical failure was related to the location of the stricture at the rectosigmoid junction (P=0.03). There were four SEMS-related complications: one fecal obstruction, one haemorrhage treated with APC and two silent perforations which were noted during surgical resection. The mean time between SEMS insertion and surgical treatment was 19 days (range 6-80 days) and the most frequent intervention was a left hemicolectomy (46.9%). No intraoperative mortality and morbidity, or postoperative mortality were observed. The postoperative morbidity rate was 18.8% (two wound infections, one deep venous thrombosis, one case of pneumonia and one anastomotic dehiscence). Finally, after discharge from hospital, a total of 29 patients (90%) were stoma free. At the end of the follow-up period, 24 patients are still alive and the mean survival rate was 37.3±18 months (range 9-72).
  
  
  CONCLUSIONS
  In our experience, SEMS placement as a BTS is a safe and effective strategy for the treatment of patients with acute LCCO.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. carmeluigiano@libero.it
authors.forename: C
authors.initials: C
authors.lastname: Luigiano
authors.forename: F
authors.initials: F
authors.lastname: Ferrara
authors.forename: R
authors.initials: R
authors.lastname: Pellicano
authors.forename: C
authors.initials: C
authors.lastname: Fabbri
authors.forename: M
authors.initials: M
authors.lastname: Bassi
authors.forename: V
authors.initials: V
authors.lastname: Cennamo
authors.forename: S
authors.initials: S
authors.lastname: Ghersi
authors.forename: C
authors.initials: C
authors.lastname: Morace
authors.forename: P
authors.initials: P
authors.lastname: Consolo
authors.forename: P
authors.initials: P
authors.lastname: Billi
authors.forename: A M
authors.initials: AM
authors.lastname: Polifemo
authors.forename: N
authors.initials: N
authors.lastname: D'Imperio
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D007558:Italy / Q000453:epidemiology; D008297:Male; D008670:Metals; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000150:complications / Q000601:surgery; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals