title: Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction.
abstract: BACKGROUND
  The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.
  
  
  METHODS
  From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.
  
  
  RESULTS
  The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P < 0.001; 8.00 ± 3.97 vs. 12.59 ± 9.07 days, P = 0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P < 0.001; 16.7 vs. 37.3%, P = 0.003). Kaplan-Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81).
  
  
  CONCLUSIONS
  Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.
authors.affiliation: Department of Gastrointestinal Surgery, The First Hospital of Putian, Fu Jian, 351100, China.
authors.forename: Zhi-Xiong
authors.initials: ZX
authors.lastname: Li
authors.affiliation: Department of General Surgery, The First Hospital of Nan Ping, Fu Jian, 353000, China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Wu
authors.affiliation: Department of Pathology, The First Hospital of Putian, Fu Jian, 351100, China.
authors.forename: Hai-yan
authors.initials: HY
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Wen-Ju
authors.initials: WJ
authors.lastname: Chang
authors.affiliation: Center for Therapeutic Research of Hepatocarcinoma, Beijing 302 Hospital, Beijing, 100000, China.
authors.forename: Xiu-juan
authors.initials: XJ
authors.lastname: Chang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Tuo
authors.initials: T
authors.lastname: Yi
authors.affiliation: Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Jing-Wen
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Qing-Yang
authors.initials: QY
authors.lastname: Feng
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: De-Xiang
authors.initials: DX
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. wei.ye@zs-hospital.sh.cn.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. zhong.yunshi@zs-hospital.sh.cn.
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colorectal cancer; Endoscopy; Intestinal obstruction; Prognosis; Self-expandable metal stent; Surgery