title: Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding.
abstract: BACKGROUND
  Endoscopic colorectal stenting may be performed as a bridge to surgery in patients with malignant colorectal obstruction, and has been reported to be associated with a high rate of successful primary anastomosis, low rate of stoma formation, and shorter hospital stay. However, the results of recent studies suggest that colorectal stenting could potentially worsen the prognosis. This study aimed to compare outcomes between patients who underwent colorectal stenting as a bridge to surgery and patients who underwent curative surgery only for malignant colorectal obstruction.
  
  
  METHODS
  This study included patients with malignant colorectal obstruction and symptomatic bowel dilatation who were treated by stenting as a bridge to surgery (stent group, n = 27) or surgical resection only (surgery-only group, n = 29) between May 2009 and May 2012. The short-term outcomes evaluated were the primary anastomosis rate, length of hospital stay, and rates of emergency and open surgery. The long-term outcomes evaluated were overall survival (OS) and recurrence-free survival (RFS).
  
  
  RESULTS
  The primary outcomes were similar in the two groups. There were no significant differences between the stent and surgery-only groups in 3-year OS (85.2 vs. 82.8%; p = 0.655) or 3-year RFS (80.7 vs. 78.6%; p = 0.916). The odds ratio for seeded metastasis after perforation either during or after stent placement was 46.0 (95% CI, 2.0-1,047.8; p = 0.016).
  
  
  CONCLUSIONS
  Colorectal stenting as a bridge to surgery showed no significant short- or long-term benefits compared with surgery only, and was associated with peritoneal seeding after perforation. Stenting before surgery should therefore only be considered in patients with a high risk of complications associated with emergency surgery.
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea. pmcac@hanmail.net.
authors: Su Jin
authors: SJ
authors: Kim
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea. mdkhwook@gmail.com.
authors: Hyung Wook
authors: HW
authors: Kim
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Su Bum
authors: SB
authors: Park
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Dae Hwan
authors: DH
authors: Kang
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Cheol Woong
authors: CW
authors: Choi
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Byeong Jun
authors: BJ
authors: Song
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Joung Boom
authors: JB
authors: Hong
authors: Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 626-770, Korea.
authors: Dong Jun
authors: DJ
authors: Kim
authors: Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors: Byung Soo
authors: BS
authors: Park
authors: Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors: Gyung Mo
authors: GM
authors: Son
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery; D004638:Emergency Treatment / Q000706:statistics & numerical data; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010537:Peritoneum / Q000601:surgery; D015607:Stents / Q000009:adverse effects*; D054047:Surgical Stomas / Q000706:statistics & numerical data; D016019:Survival Analysis
keywords: Acute Obstruction; Colonic cancer; Self-expandable metallic stent