title: Short-term outcomes following the use of self-expanding metallic stents in acute malignant colonic obstruction--a single centre experience.
abstract: BACKGROUND
  Colonic self-expanding metallic stents (SEMS) may provide prompt relief of acute malignant colorectal obstruction (AMCO) and are increasingly used either palliatively or as a bridge to surgery (BTS) in patients in whom a definitive surgical approach is unsuitable. We evaluated short-term outcomes of malignant colorectal obstructive patients who underwent SEMS insertion in our institution over a 3-year period.
  
  
  METHODS
  A prospectively maintained database was reviewed to identify all patients who presented to our institution with AMCO between August 2010 and 2013 and who were treated with a SEMS either temporarily or permanently. Additional data was retrieved from chart reviews and operation notes.
  
  
  RESULTS
  Sixteen patients (12 males, 4 females) each had a single stent inserted during the study period, either palliatively (n = 11) or as a BTS (n = 5). The technical and clinical success rates were both 87.5% (14/16). The two unsuccessful stenting cases both had disseminated disease and required emergency surgery while five patients with curable disease proceeded to elective resections. There was no procedure-related mortality or stent-related perforations. The mean (standard deviation) length of stay post acute surgery was longer than elective surgery [45 ± 21.2 vs. 15.8 ± 4.0, days]. All patients in the BTS group were stoma-free post-operatively, while both patients who had emergency surgery ended up with permanent stomas. Finally, the stent complication rate was 6.2% (1/16), secondary to migration.
  
  
  CONCLUSIONS
  Although limited by a small sample size, the study shows that SEMS have favourable short-term outcomes. Further adequately powered trials are needed to confirm those findings.
authors.affiliation: Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: Shaheel M
authors.initials: SM
authors.lastname: Sahebally
authors.affiliation: Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: Azhar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland. Electronic address: fiachra.cooke@hse.ie.
authors.forename: Fiachra
authors.initials: F
authors.lastname: Cooke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D004867:Equipment Design; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bridge to surgery; Colorectal cancer; Malignant colorectal obstruction; Palliative; Self-expanding metallic stent