Application Of Endoscopic Self-expandable Metallic Stents Used As A "Bridge To Surgery" In Obstructing Colorectal Cancer

Objective:The aim of this study is to assess the clinical outcomes : endoscopic self-expandable metallic stents (SEMS) are being used as a"bridge to surgery"in obstructing colorectal cancer (CRC).Methods: Collected information of 73 patients with a diagnose of obstructing colorectal cancer from July 2007 to November 2010 in our hospital (Fujian Medical University Union Hospital), of which 14 ones were treated with endoscopic colonic stenting as a bridge to an elective resection (stent-group). The others were treated with surgery without stent (traditional-group). Compared the difference of surgical options, surgical time, blood loss, complication rate, postoperative hospitalization time, postoperative abdominal drainage time, postoperative fasting time and survival curves between the two groups.Results: The two groups were similar in terms of age, sex distribution, presence of co-morbidity, tumor location distribution and tumour stage distribution. In contrast with the traditional-group, the proportion of laparoscopic surgery and one-stage resection was higher in stent-group (P<0.05). The complication rate in stent-group was lower than traditional-group. When compared with traditional-group, blood loss in stent-group was less. It was shorter in postoperative hospitalization time, postoperative abdominal drainage time, postoperative fasting time, comparing stent-group with traditional-group (P<0.05). The overall survival rate in stent-group was higher than traditional-group (P<0.05). The surgical time was similar in two groups.Conclusions: Colonic stent insertion followed by elective surgery appears more effective than emergency surgery under base-case conditions. It makes more opportunities for patients followed laparoscopic surgery and one-stage excision anastomosis. It can reduce operation injury bleeding and surgery complications, promote the recovery after the operative and play a role in improving survival. Our findings suggest that colonic stent insertion should be offered, whenever feasible, as a bridge to elective surgery in patients presenting with malignant colonic obstruction.