title: Stenting for obstructing colon cancer: fewer complications and colostomies.
abstract: OBJECTIVE
  Colonic stenting has been used in the setting of malignant obstruction to avoid an emergent colectomy. We sought to determine whether preoperative placement of a colonic stent decreases morbidity and the rate of colostomy formation.
  
  
  METHODS
  Cases of obstructing sigmoid, rectosigmoid, and rectal cancer from January 1, 2010, to December 31, 2011, were identified in the Nationwide Inpatient Sample (NIS) database. All patients were treated at hospitals in the United States, and the database generated national estimates. Postoperative complications, mortality, and the rate of colostomy formation were analyzed.
  
  
  RESULTS
  Of the estimated 7891 patients who presented with obstructing sigmoid, rectosigmoid, or rectal cancer necessitating intervention, 12.1% (n = 956) underwent placement of a colonic stent, and the remainder underwent surgery without stent placement. Of the patients who underwent stenting, 19.9% went on to have colon resection or stoma creation during the same admission. Patients who underwent preoperative colonic stent placement had a lower rate of total postoperative complications (10.5% vs 21.7%; P < .01). There was no significant difference in mortality (4.7% vs 4.2%; P = .69). The rate of colostomy formation was more than 2-fold higher in patients who did not undergo preoperative stenting (42.5% vs 19.5%; P < .01). Preoperative stenting was associated with increased use of laparoscopy (32.6% vs 9.7%; P < .01).
  
  
  CONCLUSIONS
  Our study characterizes the national incidence of preoperative placement of a colonic stent in the setting of malignant obstruction. Preoperative stent placement is associated with lower postoperative complications and a lower rate of colostomy formation. The results support the hypothesis that stenting as a bridge to surgery may benefit patients by converting an emergent surgery into an elective one.
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Allan
authors.initials: A
authors.lastname: Mabardy
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Miller
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Rachel
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Joseph
authors.initials: J
authors.lastname: Coury
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Alan
authors.initials: A
authors.lastname: Hackford
authors.affiliation: Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, Massachusetts.
authors.forename: Haisar
authors.initials: H
authors.lastname: Dao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003125:Colostomy / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome
keywords: Colonic obstruction; Malignant bowel obstruction; Obstructing colon cancer
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