title: Stenting as first-line management for all patients with nonperforating left-sided obstructing colorectal cancer.
abstract: OBJECTIVE
  Since 2005, we have used self-expanding metal stents (SEMS) as primary treatment for all patients with left-sided obstructing colorectal cancer without evidence of perforation. The purpose of this study was to assess the safety and efficacy of this treatment.
  
  
  METHODS
  This was a prospective study of consecutive patients with left-sided obstructing colorectal cancer without perforation or peritonitis treated between January 2005 and June 2009. SEMS placement was attempted in all cases. Emergency surgery was reserved for patients in whom a stent placement failed. After successful decompression, surgery was offered to patients with potentially curable disease.
  
  
  RESULTS
  Seventy-seven patients were included, with successful SEMS placement in 60/77 (78%) patients, 25 as a bridge to surgery and 35 for palliation. Immediate complications occurred in two (3%) cases. There was no mortality. Of 35 patients in whom SEMS was for palliation, 32 (91%) avoided surgery altogether. A stoma was fashioned in 5 (8.3%) of the 60 patients who were successfully stented, and in 12 (71%) of the 17 patients in whom stenting failed (P = 0.0001).
  
  
  CONCLUSIONS
  A SEMS-based management protocol for patients with large bowel obstruction due to colorectal cancer is safe and effective.
authors.affiliation: Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Warden
authors.forename: D
authors.initials: D
authors.lastname: Stupart
authors.forename: P
authors.initials: P
authors.lastname: Goldberg
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Colonic stents; bowel obstruction; colorectal cancer