title: [Colonic stenting: an opportunity with a risk : A critical evaluation].
abstract: BACKGROUND
  Frequently, the first clinical sign of colorectal cancer is complete obstruction, which has to be considered an emergency situation. The treatment goal is to overcome ileus including reduction of the associated high morbidity and mortality. Therefore, alternative therapeutic options to emergency surgery have been sought in order to allow adequate preparation for elective surgery or stabilization of palliative patients and avoid colostoma. Therapeutic results of the placement of self-expanding metal stents (SEMS) are discussed in terms of a single-center, retrospective observational study.
  
  
  METHODS
  In 35 patients with a clinically manifest stenosis of colonic cancer, it was attempted to insert SEMS to treat ileus as the first therapeutic step. Therapeutic results were investigated with regard to technical and clinical success, spectrum and rate of complications, and survival time, differentiating between a palliative and curative group of patients.
  
  
  RESULTS
  Primary placement of a stent was achieved in 29 of 35 patients (82.9 %); 14 underwent the procedure with palliative and 15 with curative intention. Stent location was mainly the left hemicolon. In 2 of 15 patients (13.3 %), emergency surgery within 48 h was required because of complications, whereby in 13 patients (86.7 %), 6 patients (46.2 %) underwent elective open surgery and 7 patients (53.8 %) underwent a laparoscopic procedure. In all patients treated with curative intent, primary anastomosis was achieved, thus, avoiding a colostoma. Survival times of the palliative and curative patient groups were on average 7 and 28 months, respectively.
  
  
  CONCLUSIONS
  In carefully selected cases, placement of SEMS in malignant stenosis of the left hemicolon with ileus can be considered a reasonable therapeutic alternative to emergency surgery since it allows surgical intervention with curative intention under more favorable conditions and also avoids a colostoma.
authors.affiliation: Klinik für Viszeral- und Gefäßchirurgie, HELIOS Klinikum Aue, Gartenstraße 6, 08280, Aue, Deutschland, roland.albrecht@helios-kliniken.de.
authors.forename: R
authors.initials: R
authors.lastname: Albrecht
authors.forename: H
authors.initials: H
authors.lastname: Hönicke
authors.forename: C
authors.initials: C
authors.lastname: Bochmann
authors.forename: U
authors.initials: U
authors.lastname: Settmacher
authors.forename: T
authors.initials: T
authors.lastname: Wirth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005260:Female; D005858:Germany; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000628:therapy*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis