title: The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic colorectal cancer.
abstract: BACKGROUND
  Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful stenting in patients with obstructive metastatic colorectal cancer.
  
  
  METHODS
  This was a tertiary-care center retrospective study.
  
  
  METHODS
  From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful stenting.
  
  
  METHODS
  Self-expandable metal stent placement and primary colectomy were performed.
  
  
  METHODS
  The stoma formation rate and complications were measured.
  
  
  RESULTS
  In patients with successful stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful endoscopic stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04).
  
  
  CONCLUSIONS
  This was a retrospective, single-center study.
  
  
  CONCLUSIONS
  To reduce stent-related late complications, primary colectomy after successful endoscopic stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
authors.affiliation: 1Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea 2Department of Surgery, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Lee
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Byung So
authors.initials: BS
authors.lastname: Min
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010030:Ostomy; D011475:Prosthesis Failure / Q000009:adverse effects; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*