Journal Article


Glen A Doherty
Des C Winter
P Ronan O'Connell
Hugh E Mulcahy
John M P Hyland
Ciaran Judge
Blathnaid Nolan
Dara O Kavanagh


Medicine & Nursing

aged intestinal obstruction middle aged stents mortality endoscopy gastrointestinal etiology aged 80 and over patient readmission complications secondary peritoneal neoplasms liver neoplasms retrospective studies colectomy colorectal neoplasms statistics numerical data humans emergencies neoplasm recurrence local surgical stomas surgery female anastomosis surgical male

A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. (2013)

Abstract The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies. The aim of the current study was to compare outcomes. This was an observational, comparative study. This study was conducted at a tertiary referral center and university teaching hospital. Patients with malignant colonic obstruction (n = 49) treated by either emergency surgery (n = 26) or with stent placement (n = 23) as a bridge to surgery were identified and followed. Short-term outcomes including stoma rates and postoperative morbidity and medium-term oncological outcomes were compared based on an "intention-to-treat" analysis. Patients in both groups were well matched on clinicopathological parameters. Technical and clinical successful stent deployment was achieved in 91% and 83%. This did not adversely impact cancer-specific and overall survival (log rank = nonsignificant). No difference was observed in stoma rates, primary anastomosis rates, perioperative mortality rates, or reoperation rates between the 2 groups. Significantly fewer patients underwent total colectomy in the stent group in comparison with the emergency surgery group (1/23 vs 6/26: p = 0.027). There was no difference in postoperative morbidity (59% vs 66%: p = 0.09). There was a significant reduction in readmission rates in the stent group (5/26 vs 0/23: p = 0.038). The small sample size of this study could lead to type II error. In addition, the study was nonrandomized and demonstrated a limited length of follow-up. Despite a high rate of technical and clinical success in selected patients with colonic obstruction, stenting has no impact on stoma rates. Despite concerns about the rate of stent-associated perforation, stenting does not adversely impact disease progression or survival. Future comparative trials are essential to better define the role of stenting in this setting and to ensure that we are not using costly technology to create an elective operative situation without concomitant patient benefits.
Collections Ireland -> University College Dublin -> PubMed

Full list of authors on original publication

Glen A Doherty, Des C Winter, P Ronan O'Connell, Hugh E Mulcahy, John M P Hyland, Ciaran Judge, Blathnaid Nolan, Dara O Kavanagh

Experts in our system

Glen A Doherty
University College Dublin
Total Publications: 57
P R O'Connell
University College Dublin
Total Publications: 75
Hugh E Mulcahy
University College Dublin
Total Publications: 43
John Hyland
Dublin Business School
Total Publications: 47
Blathnaid Nolan
Trinity College Dublin
Total Publications: 8