title: Surgical failure after colonic stenting as a bridge to surgery.
abstract: OBJECTIVE
  To identify risk factors for surgical failure after colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction.
  
  
  METHODS
  The medical records of patients who underwent stent insertion for malignant colonic obstruction between February 2004 and August 2012 were retrospectively reviewed. Patients with malignant colonic obstruction had overt clinical symptoms and signs of obstruction. Malignant colonic obstruction was diagnosed by computed tomography and colonoscopy. A total of 181 patients underwent stent insertion during the study period; of these, 68 consecutive patients were included in our study when they had undergone stent placement as a bridge to surgery in acute left-sided malignant colonic obstruction due to primary colon cancer.
  
  
  RESULTS
  Out of 68 patients, forty-eight (70.6%) were male, and the mean age was 64.9 (range, 38-89) years. The technical and clinical success rates were 97.1% (66/68) and 88.2% (60/68), respectively. Overall, 85.3% (58/68) of patients underwent primary tumor resection and primary anastomosis. Surgically successful preoperative colonic stenting was achieved in 77.9% (53/68). The mean duration, defined as the time between the SEMS attempt and surgery, was 11.3 d (range, 0-26 d). The mean hospital stay after surgery was 12.5 d (range, 6-55 d). On multivariate analysis, the use of multiple self-expanding metal stents (OR = 28.872; 95%CI: 1.939-429.956, P = 0.015) was a significant independent risk factor for surgical failure of preoperative stenting as a bridge to surgery. Morbidity and mortality rates in surgery after stent insertion were 4.4% (3/68) and 1.5% (1/68), respectively.
  
  
  CONCLUSIONS
  The use of multiple self-expanding metal stents appears to be a risk factor for surgical failure.
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Kwang An
authors.initials: KA
authors.lastname: Kwon
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Jong Joon
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Jeong-Heum
authors.initials: JH
authors.lastname: Baek
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Kyoung Oh
authors.initials: KO
authors.lastname: Kim
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Dong Kyun
authors.initials: DK
authors.lastname: Park
authors.affiliation: Jung Ho Kim, Kwang An Kwon, Jong Joon Lee, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Dong Kyun Park, Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405760, South Korea.
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
keywords: Colorectal neoplasms; Endoscopy; Intestinal obstruction; Risk factors; Stents