Outcome of bridge to surgery stenting for obstructive left colon cancer

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Excerpt

Obstructive colon cancer accounts for 10–30% of all colon cancer1 and is traditionally treated with emergency surgery (ES) as a multistage operation or intraoperative lavage with primary anastomosis, but this strategy has disadvantages, such as high probability of stoma formation and significant morbidity and mortality.2
Many institutions have used stents as a bridge to surgery to avoid ES. A stent stabilizes the patient's condition and makes bowel preparation and a full colonoscopy possible. Therefore, stents improve morbidity, mortality, the stoma formation rate and patient recovery compared with ES.3
However, air or dye insufflation, inserting the guidewire and/or expanding the stent can irritate the cancer. This may appear contradictory to the non‐touch principle of cancer surgery and theoretically could lead to tumour cell spillage. Maruthachalam et al.5 reported that occult tumour cell markers are significantly higher in peripheral blood after colonoscopic insertion of a stent.
The long‐term oncological outcomes of using stents as a bridge to surgery compared with ES are controversial and required more data. We compared short‐ and long‐term outcomes of the two groups from six centres for a left colon malignant obstruction.

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