title: Colonic acute malignant obstructions: effectiveness of self-expanding metallic stent as bridge to surgery.
abstract: OBJECTIVE
  Bowel obstruction is a frequent event in patients with adenocarcinoma, affecting, in some series, almost one-third of the patients. In the last decades, in addition to surgery, self-expanding metallic stents (SEMSs) are available both as a bridge to surgery (BTS) or palliation. The aim of our study was to demonstrate the safety and efficacy of the use of SEMSs as BTS in selected patients with acute colonic malignant obstructions.
  
  
  METHODS
  In total, 125 patients with malignant colonic obstruction who underwent emergency surgery or stent insertion were retrospectively enrolled in our study; 62 patients underwent surgery initially, whereas 62 were subjected to stenting as BTS. The 6-month and 1-year survival rates after the procedure (stenting or surgery) and short-term and long-term complication rates were considered as primary endpoints; the recanalization rate after Hartmann's procedure and the length of hospitalization were considered as secondary endpoints.
  
  
  RESULTS
  On comparing the surgery group (SG) and the BTS group (BG), we observed a lower short-term complication rate (p<0.05) and a reduction in the mean hospital stay (16.1±7.7 vs. 13.5±3.0, p<0.05) in the latter. No differences in long-term complications were found. The recanalization rate after Hartmann's procedure was higher in BG than in SG, although this was not statistically significant.
  
  
  CONCLUSIONS
  Our experience shows that SEMS insertion is a safe and effective technique in selected patients with colonic malignant obstruction; the reduction in hospital stay and short-term complications in BG is an important cost-saving aim.
authors.affiliation: Department of Surgery, Oncology and Human Pathology, University Hospital of Messina, Via Consolare Valeria, Messina, Italy. marcellocintolo@hotmail.it.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Consolo
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Giacobbe
authors.forename: Marcello
authors.initials: M
authors.lastname: Cintolo
authors.forename: Andrea
authors.initials: A
authors.lastname: Tortora
authors.forename: Fausto
authors.initials: F
authors.lastname: Famà
authors.forename: Maria
authors.initials: M
authors.lastname: Gioffrè Florio
authors.forename: Socrate
authors.initials: S
authors.lastname: Pallio
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D015996:Survival Rate