Self-Expandable Stent Before Elective Surgery vs . Emergency Surgery for the Treatment of Malignant Colorectal Obstructions: Comparison of Primary Anastomosis and Morbidity Rates

Martínez-Santos, Cristina; Lobato, R Fernández; Fradejas, José; Pinto, Isabel; Ortega-Deballon, P.; Moreno-Azcoita, Mariano

doi:10.1007/s10350-004-6190-4

Cited by 243 publications

(164 citation statements)

References 16 publications

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“…Treatment with dolantin was not satisfactory, and venous injection of omeprazole and peridural anesthesia were used for 2 days to relieve the pain. In terms of pain after stent placement, the incidence (16.7%) was slightly higher than those reported previously [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . This may be attributable to the types of lesions and size of the stents.…”

Section: Discussionmentioning

confidence: 61%

Complications of stent placement for benign stricture of gastrointestinal tract

Cheng¹,

Li²,

Chen³

et al. 2004

WJG

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Section: Discussionmentioning

confidence: 61%

Complications of stent placement for benign stricture of gastrointestinal tract

Cheng¹,

Li²,

Chen³

et al. 2004

WJG

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“…primary anastomosis rates at least twice as high as those aft er emergency surgery and with a remarkable decrease in number of colostomies ( 20,21 ). Furthermore, placement of the SEMS allows the treating physician to perform a complete preoperative colonoscopy to exclude synchronous lesions ( 22 ) and to perform accurate tumoral staging -essential for determining the best therapeutic option for the patient, considering that up to 50 % of patients who undergo emergency laparotomy are not candidates for curative surgery ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

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OBJECTIVES:To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS:This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS:A total of 182 patients were enrolled with obstructive tumor in the left colon (85 % ), rectum (11 % ), or splenic fl exure (4 % ). Of these patients, 86 % had localized colorectal cancer without metastasis. Procedural success was 98 % (177 / 181). Clinical success was 94 % (141 / 150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8 % (13 / 167), including perforation in 3 % (5 / 167), stent migration in 1.2 % (2 / 167), bleeding in 0.6 % (1 / 167), persistent colonic obstruction in 1.8 % (3 / 167), and stent occlusion due to fecal impaction in 1.2 % (2 / 167). One patient died from complications related to surgical management of a perforation.CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

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“…The use of stents as a bridge to surgery has been validated by studies 19,24,26 that have shown less morbidity, less stoma formation, and shorter hospital stays compared to emergency surgery for colorectal obstruction. Three studies have also demonstrated that stent placement is costeffective compared to surgery.…”

Section: Discussionmentioning

confidence: 99%