title: Decompression of acute left-sided malignant colorectal obstruction: comparing transanal drainage tube with metallic stent.
abstract: OBJECTIVE
  Acute left-sided colorectal malignant obstruction is a life-threatening condition and need emergent treatment. Many nonsurgical treatments to palliate obstruction have been developed in clinics. The aim of this study was to evaluate the clinical effects of transanal drainage tube (TDT) and metallic stent for the decompression of acute left-sided malignant colorectal obstruction.
  
  
  METHODS
  Twenty-nine patients with acute left-sided malignant colorectal obstruction were enrolled in this study from January 2005 to December 2010, they were randomly divided into TDT group (13 patients) and metallic stent group (16 patients).
  
  
  RESULTS
  There were 13 cases in TDT group (male:female=8:5, age from 65 to 80 y, mean age was 72.6±4.7 y). The sites of lesions were located in the rectum of 3 patients, sigmoid colon of 7 patients, and descending colon of 3 patients. TDT was successfully inserted in 11 cases (84.6%). Among the 11 patients, 1-stage operation with sufficient lymph node dissection was performed in 8 cases after adequate lavage without complications. One case underwent emergent Hartmann operation because of colonic tumor perforation 3 days after ileus tube decompression. Two cases were discharged without surgery after relief of symptom. There were 16 cases in the metallic stent group (male:female=10:6 age from 48 to 86 y, mean age was 73.3±8.5 y). The sites of the lesions were located in the rectum of 4 patients, sigmoid colon of 6 patients, and descending colon of 6 patients. Successful stent placement was achieved in 13 cases (81.3%) with no severe complications. Among the 13 patients, 1-stage operation with sufficient lymph node dissection was performed in 7 cases and 6 cases refused to underwent surgery with stent as the definitive palliative treatment. The price of a TDT is only one third of an expandable metallic stent.
  
  
  CONCLUSIONS
  Both TDT and metallic stent can achieve preoperative colonic lavage for 1-stage operation for patients with acute left-sided malignant colorectal obstruction with no increase in complications.
authors.affiliation: Departments of *Gastroenterology †Interventional Therapy, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Li
authors.forename: Shi-Bin
authors.initials: SB
authors.lastname: Guo
authors.forename: Ning-Fang
authors.initials: NF
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D015179:Colorectal Neoplasms / Q000150:complications*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D015607:Stents; D016896:Treatment Outcome