title: Colorectal stenting as a bridge to surgery reduces morbidity and mortality in left-sided malignant obstruction: a predictive risk score-based comparative study.
abstract: BACKGROUND
  The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity model, and its Portsmouth and colorectal modifications are used to predict postoperative mortality and morbidity after colorectal surgery.
  
  
  OBJECTIVE
  To compare stent placement as a bridge to surgery vs. emergency surgical resection in patients with acute left-sided colorectal cancer obstruction using P-POSSUM and CR-POSSUM.
  
  
  METHODS
  From January 2008 to December 2009, the physiological and operative scores, morbidity and mortality predicted by the P-POSSUM and CR-POSSUM scores were collected in all consecutive patients with LCCO who underwent surgical resection directly (Group A) or after stent placement (Group B).
  
  
  RESULTS
  Eighty-six patients were enrolled (Group A-41 and Group B-45). The observed 30-day mortality rate was 9.8% (4/41) in Group A and 2.4% (1/45) in Group B. The 30-day morbidity rate was 61% (25/41) in Group A and 29% (13/45) in Group B. The mean values of P-POSSUM morbidity (A=70.5% vs. B=34.3%; p=0.001), P-POSSUM mortality (A=13.6% vs. B=2.4%; p=0.001) and CR-POSSUM mortality (A=15.1% vs. B=4.9%; p=0.001) were significantly lower in the Group B patients than in the Group A patients.
  
  
  CONCLUSIONS
  Bridge to surgery strategy reduces the surgical risks in LCCO, and P-POSSUM and CR-POSSUM scores represent a good tool for comparing the two strategies.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Italy. cennamoit@yahoo.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Rocco Maurizio
authors.initials: RM
authors.lastname: Zagari
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Liza
authors.initials: L
authors.lastname: Ceroni
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mussetto
authors.forename: Tino
authors.initials: T
authors.lastname: Casetti
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Imperio
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D015607:Stents