Effectiveness of Stenting as Bridge to Surgery in Left Sided Malignant Obstructions; Single Center Results

Abstract

Aim:Intestinal obstruction due to colorectal cancer should be urgently decompressed due to high morbidity. Its treatment includes palliative interventions, emergency laparotomy and bridge to surgery. In this study, we aimed to evaluate the effects of stenting on surgical and oncological outcomes by comparing it with the emergency surgery.Method:Patients admitted between January 2019 and February 2020 due to acute malignant left-sided colon obstruction were analyzed. The groups who underwent emergency laparotomy (group E) and those who underwent elective surgery after stenting (group S) were compared. Demographic and preoperative basic characteristics, early postoperative outcomes and mortality rates of the patients were examined.Results:Forty-six patients, 20 in the stenting group (group S) and 26 in the emergency surgery group (group E) were included in the study. Age, gender, tumor location, ASA status and N stage of the groups were similar. The T stages were significantly higher in the group E (p<0.01). While technical success was achieved in 17 patients (85.0%) and clinical success in 14 patients (70.0%) in the group S, emergency laparotomy was performed in 6 patients. In 7 patients (35.0%) in group S, the surgery was completed laparoscopically. The groups were similar in terms of permanent stoma, length of stay, and 30-day mortality rates, while significantly lower complications were observed in the stenting group (15% vs 50%, p=0.013).Conclusion:Elective laparoscopic colectomy after stent decompression may be possible with less severe morbidity and lower 30 day mortality in the management of acute left-sided colon obstruction.

Keywords

• malignant obstruction
• colonic stenting
• bridge to surgery
• laparoscopic resection