title: Stenting in malignant colonic obstruction--is it a real therapeutic option?
abstract: BACKGROUND
  Malignant colonic obstruction is commonly treated surgically. Colonic stents are a therapeutic option for palliation or used as a bridge to surgery or chemotherapy.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the clinical success rate of stenting as a bridge to one-step surgery, chemotherapy, or as a palliative measure.
  
  
  METHODS
  This was a retrospective observational study.
  
  
  METHODS
  The study was conducted at a university-affiliated tertiary referral center.
  
  
  METHODS
  From 2007 to 2014, 45 patients with malignant colonic obstruction were referred for stent insertion.
  
  
  METHODS
  Patients were grouped according to three pre-defined treatment goals: group 1: restorative one-step procedure without an ostomy, group 2: completion of scheduled chemotherapy before surgery, and group 3: palliation without surgical intervention.
  
  
  RESULTS
  Group 1 included 11 patients. Three patients (27.3 %) met the treatment goal of one-step surgery. Eight patients (72.7 %) did not reach the primary goal due to stent insertion failure (four patients), stent-related complications (two patients), and failure to perform a one-step surgery after successful stent insertion (two patients). Group 2 included 12 patients. Chemotherapy was successfully completed prior to surgery in six patients (50 %). Six patients (50 %) did not achieve treatment goal due to stent insertion failure (two patients), stent migration (two patients), stent-related perforation (one patient), and mortality (one patient). Group 3 included 20 patients. Long-term palliation without surgical intervention was achieved in eight patients (40 %). Stent insertion failed in seven patients (35 %). Five patients (25 %) needed urgent surgery due to stent complications (three migrations and two perforations).
  
  
  CONCLUSIONS
  The study was limited by its retrospective nature and small sample size.
  
  
  CONCLUSIONS
  This study demonstrates only a modest success rate of colonic stents in the treatment of malignant colonic obstruction. Although colonic stenting seems to be an effective method of relieving colonic obstruction, high failure rates limits its applicability.
authors: Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
authors: Nir
authors: N
authors: Horesh
authors: Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
authors: Joseph Yosef
authors: JY
authors: Dux
authors: Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: Moshe
authors: M
authors: Nadler
authors: Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: Alon
authors: A
authors: Lang
authors: Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
authors: Oded
authors: O
authors: Zmora
authors: Institute Of Oncology, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: Einat
authors: E
authors: Shacham-Shmueli
authors: Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel.
authors: Mordechai
authors: M
authors: Gutman
authors: Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel. ron.shapiro@sheba.health.gov.il.
authors: Ron
authors: R
authors: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemotherapy; Colonic stent; Malignant colonic obstruction; One-step surgery; Palliation