title: Stent placement prior to initiation of chemotherapy in patients with obstructive, nonoperative left sided tumors is associated with fewer stomas.
abstract: Due to the potential risks associated with stent placement, European Society Gastrointestinal Endoscopy does not recommend prophylactic insertion of stents in patients without symptoms. The aim was to compare complication rates, need of surgery, colostomy formation, and survival between stent placement prior to start of chemotherapy (SEMS group) and upfront ChT (ChT group) in patients with endoscopically non-transverable metastatic left-sided colorectal cancer.
  
  
  METHODS
  Gender, age, CEA, tumor location, sites of metastatic disease, peritoneal involvement, liver involvement, and angiogenesis inhibitors administration, were recorded. Complication rates, need of surgery, stoma creation, and survival were compared between both groups by univariate and multivariate test. Complications of SEMS placement in both groups were compared.
  
  
  RESULTS
  We studied 75 men and 40 women, with a mean age of 66.3 years. Overall complication and perforation rates were similar but patients in the ChT group had a significant higher need of surgery and subsequent stoma creation. Perforation after SEMS placement rates were higher in patients receiving ChT than in patients without ChT. Survival was related to peritoneal carcinomatosis and administration of biological agents.
  
  
  CONCLUSIONS
  SEMS placement prior to ChT administration dismissed the need of subsequent surgery and decreased the rates of permanent stoma formation.
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Suárez
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Marín
authors.affiliation: Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Vera
authors.affiliation: Department of Surgery, Section of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida.
authors.forename: Dorin
authors.initials: D
authors.lastname: Colibaseanu
authors.affiliation: Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Vila
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Ciga
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Oronoz
mesh_terms: D000368:Aged; D001688:Biological Products / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003125:Colostomy / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011300:Preoperative Care; D000069322:Self Expandable Metallic Stents; D054047:Surgical Stomas / Q000706:statistics & numerical data*
chemical_list: D001688:Biological Products
keywords: colorectal cancer; metastatic colorectal cancer; self-expanding metallic stent; synchronous metastatic colorectal cancer; upfront chemotherapy