title: [Stent placement or acute resection in colonic obstruction?].
abstract: When choosing a treatment for obstructing left-sided colonic carcinoma, a distinction is made between patients with increased surgical risk and patients without increased surgical risk. Patients with increased surgical risk (age > 70 years or ASA class ≥ 3) do have an indication for stent placement as a bridge to elective surgery, or as an alternative, a decompressing colostomy. Acute resection is the treatment of choice in patients without increased surgical risk, given the oncological risk associated with guidewire-related or stent-related perforation. Stent placement is recommended as the palliative treatment for patients with malignant colonic obstruction, unless the patient is simultaneously being treated with angiogenesis inhibitors (e.g. bevacizumab) as these increase the risk of stent perforation. Expertise of at least 20 colonic stent procedures is required for stent placement.
authors.affiliation: Academisch Medisch Centrum, Amsterdam.
authors.forename: Emo E
authors.initials: EE
authors.lastname: van Halsema
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Frank
authors.initials: F
authors.lastname: ter Borg
authors.forename: Esther C J
authors.initials: EC
authors.lastname: Consten
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemmelman
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010166:Palliative Care; D018570:Risk Assessment; D015607:Stents
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab