title: Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages.
abstract: OBJECTIVE
  To clarify the advantages and disadvantages of stenting as a bridge to surgery (BTS) by comparing the clinical features and outcomes of patients who underwent BTS with those of patients who underwent emergency surgery (ES).
  
  
  METHODS
  We assessed technical success, clinical success, surgical procedures, stoma formation, complications, clinicopathological features, and Onodera's prognostic nutritional index (OPNI) in patients who underwent BTS and those who underwent ES.
  
  
  RESULTS
  Twenty-six patients underwent stenting, which was successful in 22 (BTS group). The remaining four patients with unsuccessful stenting underwent emergency surgery. A total of 22 patients underwent emergency surgery (ES group). The rates of technical and clinical success were 85.0 and 81.0 %, respectively. The proportion of patients able to be treated by laparoscopic surgery (P = 0.0001) and avoid colostomy (P = 0.0042) was significantly higher in the BTS group. Although the incidence of anastomotic leakage in the two groups was not significantly different, it was significantly reduced by colonoscopic evaluation of obstructive colitis (P = 0.0251). The mean number of harvested lymph nodes (P = 0.0056) and the proportion of D3 lymphadenectomy (P = 0.0241) were significantly greater in the BTS group. Perineural invasion (PNI) was noted in 59.1 and 18.2 % of the BTS group and ES group patients, respectively (P = 0.0053). OPNI and serum albumin decreased significantly after stenting (P = 0.0084).
  
  
  CONCLUSIONS
  The advantages of stenting as a BTS were that it avoided colostomy and allowed for laparoscopic surgery and lymphadenectomy, whereas its disadvantage lay in the decreased PNI and OPNI levels. A larger study including an analysis of prognosis is warranted.
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan. nharaguchi@gesurg.med.osaka-u.ac.jp.|Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita Yamadaoka 2-2-E2, Osaka, 565-0871, Japan. nharaguchi@gesurg.med.osaka-u.ac.jp.
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Haraguchi
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Gastroenterology, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sakakibara
authors.affiliation: Department of Gastroenterology, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Mita
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita Yamadaoka 2-2-E2, Osaka, 565-0871, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita Yamadaoka 2-2-E2, Osaka, 565-0871, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015596:Nutrition Assessment; D012709:Serum Albumin; D015607:Stents; D025321:Surgery, Computer-Assisted
chemical_list: D008670:Metals; D012709:Serum Albumin
keywords: Bridge to surgery; Colorectal cancer; Obstructive colorectal cancer; Self-expandable colonic stent