Bridging Metallic Stent Placement in Acute Obstructed Left Sided Malignant Colorectal Cancer: Optimal Time for Surgery
Siripong Sirikurnpiboon MD*, Burin Awapittaya MD*, Paiboon Jivapaisarnpong MD*, Thawee Rattanachu-ek MD*, Jerasak Wannaprasert MD*, Sukij Panpimarnmas MD*
Affiliation : * Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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.
Keywords : Colonic stent, Colorectal cancer, Obstruction
