Bridging metallic stent placement in acute obstructed left sided malignant colorectal cancer: optimal time for surgery.

BACKGROUND

Colonic stenting is now the preferred treatment either for palliation or as a bridge to surgery for obstructed colorectal cancer. It reduces complications from emergency surgery and the need for colostomy formation. However, stent perforation can lead to peritoneal tumor spillage, a higher rate of infection and changing the risk of a potentially curable disease to an incurable one. Therefore, it is important to study the optimum time for operation after stent insertion.

MATERIAL AND METHOD: From January 2006 to January 2012, 30 cases of acute left-sided malignant colorectal obstruction were managed by expandable metallic stent (SEMS) as a bridge to surgery. In all, 19 males and 11 females with mean age of 60.07±12.19 years (range 40-80 years) were included in the study. The obstructed locations were 1 case at the transverse colon, 6 cases at the descending colon, 13 cases at the sigmoid colon, 5 cases at the upper third at the rectum and 5 cases involving the middle third of the rectum.

RESULTS

The perforation of SEMS was founded in 11 cases (36.67%). The mean bridging time before operation in the nonperforated group was 5.54 (±1.29) days shorter than in the perforated group, 10.54 (±4.82) days (p<0.001). All of the subjects in the perforated group reported clinical lower abdominal pain without sign of peritonitis, developed in an average 4.5 days (3-7 days).

CONCLUSION

The optimum bridging time for surgery should be within 5 days.