title: A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.
abstract: BACKGROUND
  The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.
  
  
  OBJECTIVE
  The aim of the current study was to compare outcomes.
  
  
  METHODS
  This was an observational, comparative study.
  
  
  METHODS
  This study was conducted at a tertiary referral center and university teaching hospital.
  
  
  METHODS
  Patients with malignant colonic obstruction (n = 49) treated by either emergency surgery (n = 26) or with stent placement (n = 23) as a bridge to surgery were identified and followed.
  
  
  METHODS
  Short-term outcomes including stoma rates and postoperative morbidity and medium-term oncological outcomes were compared based on an "intention-to-treat" analysis.
  
  
  RESULTS
  Patients in both groups were well matched on clinicopathological parameters. Technical and clinical successful stent deployment was achieved in 91% and 83%. This did not adversely impact cancer-specific and overall survival (log rank = nonsignificant). No difference was observed in stoma rates, primary anastomosis rates, perioperative mortality rates, or reoperation rates between the 2 groups. Significantly fewer patients underwent total colectomy in the stent group in comparison with the emergency surgery group (1/23 vs 6/26: p = 0.027). There was no difference in postoperative morbidity (59% vs 66%: p = 0.09). There was a significant reduction in readmission rates in the stent group (5/26 vs 0/23: p = 0.038).
  
  
  CONCLUSIONS
  The small sample size of this study could lead to type II error. In addition, the study was nonrandomized and demonstrated a limited length of follow-up.
  
  
  CONCLUSIONS
  Despite a high rate of technical and clinical success in selected patients with colonic obstruction, stenting has no impact on stoma rates. Despite concerns about the rate of stent-associated perforation, stenting does not adversely impact disease progression or survival. Future comparative trials are essential to better define the role of stenting in this setting and to ensure that we are not using costly technology to create an elective operative situation without concomitant patient benefits.
authors.affiliation: Center for Colorectal Disease, St Vincent University Hospital, Elm Park, and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
authors.forename: Dara O
authors.initials: DO
authors.lastname: Kavanagh
authors.forename: Blathnaid
authors.initials: B
authors.lastname: Nolan
authors.forename: Ciaran
authors.initials: C
authors.lastname: Judge
authors.forename: John M P
authors.initials: JM
authors.lastname: Hyland
authors.forename: Hugh E
authors.initials: HE
authors.lastname: Mulcahy
authors.forename: P Ronan
authors.initials: PR
authors.lastname: O'Connell
authors.forename: Des C
authors.initials: DC
authors.lastname: Winter
authors.forename: Glen A
authors.initials: GA
authors.lastname: Doherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010359:Patient Readmission / Q000706:statistics & numerical data; D010534:Peritoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies; D015607:Stents; D054047:Surgical Stomas