The Minimal Invasive Treatment Of Left-sided Malignant Colorectal Obstruction

Objective: To explore the value of stent and ileus tube insertion through endoscopicapproach as a bridge to laparoscopic surgery in the management of left-sidedmalignant colorectal obstruction.Methods: From2008to2012,35patients with left-sided malignant colorectalobstruction have been treated with SEMS (self-expanding metallic stent) or ileus tubeinsertion as a bridge to laparoscopic surgery. Data were analyzed retrospectively.Results:24of total26patients were successfully treated with SEMS insertion withall24patients got successful decompression.1patient got perforation during theinsertion of the stent.24patients with successful decompression subsequently treatedwith laparoscopic colorectal surgery with20got successful one-stage radical surgeryand there was no anastomotic leakage. Conversion to open surgery was required in1patient owing to bulky tumor and extensive adhesion. Two patients treated withcovering ileostomy and the stomas were reversed eventually.9patients were treatedwith ileus tube,8patients got successful one stage laparoscopic surgery,1patient gotanastomotic leakage.Conclusion: SEMS or ileus tube insertion as a bridge to laparoscopic surgery formalignant left-sided colorectal obstruction was a feasible and promising approach. ASEMS or ileus tube allows patients to recover from acute obstruction and buys timefor proper preoperative investigations and then result in a safe selective laparoscopicsurgery and reduce the need for a stoma. Background: Emergency surgical decompression is mandatory as the traditionaltreatment option for left-sided malignant colorectal obstruction, it is associated withhigh risk of mortality and morbidity as well as a high rate of defunctioning stoma. Useof self-expanding metallic stents (SEMS) as a bridge to surgery has been suggested asa promising management for acute left-sided malignant colorectal obstruction. Thismeta-analysis is aim to assess the effectiveness and safety of colonic stents used as abridge to surgery in the management of left-sided malignant colorectal obstruction.Methods: A systematic search was conducted in Medline, Pubmed, CNKI andWANGFANG for potentially relevant trials comparing colonic stenting used as abridge to surgery versus emergency surgery from January1991to December2012.Result: Five published studies were included in this systematic review. A total of237patients (140male/133female) included in our analysis,136treated with stenting vs137patients who underwent emergency surgery. In the SEMS group, the technicalsuccess rates and clinical success rate for stent placement were71.3%(97of136) and69.1%(94of136) respectively. The clinical perforation rate was5.9%(8of136) andthe silent perforation rate was8.1%(11of136). SEMS intervention resulted insignificantly higher successful primary anastomosis（62.4%vs37.1%，P=0.0004）andlower overall stoma (41.9%vs56.2%， P=0.02) rates. The rate of permanent stoma,anastomotic leak, in-hospital mortality, and overall complication were lower in theSEMS group, but there was no statistic difference.Conclusions: Use of self-expanding metallic stents (SEMS)for proper patients ofleft-sided malignant colorectal obstruction as a bridge to surgery has higher successfulprimary anastomosis and lower overall stoma rates，with no significant difference inanastomotic leak rate, complications and mortality. Further study is needed to verifythe oncologic outcome of SEMS.