title: Patients who failed endoscopic stenting for left-sided malignant colorectal obstruction suffered the worst outcomes.
abstract: BACKGROUND
  Reported outcomes of patients followed failed endoscopic stenting for acute left-sided malignant colonic obstruction remained lacking.
  
  
  OBJECTIVE
  This study aims to compare the outcomes between endoscopic stenting and emergency surgery in patients with acute left-sided malignant colonic obstruction and to identify factors that predict failed stenting.
  
  
  METHODS
  A retrospective review of all patients with acute left-sided malignant colonic obstruction in the National University Hospital, Singapore was performed.
  
  
  RESULTS
  From January 2007 to October 2013, 165 patients, with a median age of 68 years (range, 25-96), formed the study group. Sixty-nine (41.8 %) patients underwent immediate surgery. Endoscopic stenting was attempted in 96 (58.2 %) patients and was successful in 76 (79.2 %). The remaining 20 (20.8 %) failed the procedure and were operated immediately. Three of the patients who were successfully stented but did not improve clinically also required emergency surgery. Patients that failed stenting were 13.3 (95 % confidence interval (CI), 3.61-48.8; p < 0.001) times more likely to develop severe adverse events than those who were successfully stented. The group of patients who failed stenting was also 3.3 (95 % CI, 1.19-9.20; p = 0.026) times more likely to develop severe adverse events than those operated immediately. The only factor that predicted failure of stenting was a more acute angulation between the tumour and the distal lumen.
  
  
  CONCLUSIONS
  Patients who failed endoscopic stenting fared worse than those who were successfully stented and also those who underwent emergency surgery upfront. Identification of factors that predict failures may be vital to minimise morbidity in these high-risk patients.
authors.affiliation: Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Tian-Zhi
authors.initials: TZ
authors.lastname: Lim
authors.forename: Dedrick
authors.initials: D
authors.lastname: Chan
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications*; D003113:Colonoscopy; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D017211:Treatment Failure