Introductio:Emergency surgery performed on patients with acute bowel obstruction is associated with a high mortality and morbidity rate. Since 1991, the use of self-expanding metal stents (SEMS) has been introduced as an alternative management either as palliation or as a bridge to surgery. The use of SEMS as emergency management for patients with malignant bowel obstruction was introduced at Akershus Universitetssykehus (Ahus) in April 2008. The aim of our study was to evaluate the results of patients primarily treated with stents.
Methods:From April 08 to June 10, 17 patients admitted with acute colorectal obstruction were treated with stents. 6 of these patients had known inoperable colorectal cancer, and the stents were placed as palliation. 11 stents were placed as a bridge to surgery. The site of obstruction varied with 5 in rectal colon, 9 in sigmoid colon and 3 in descending colon. In one patient, 2 stents were placed initially. With one exception, where the stent most likely perforated a few hours after placement, there were no problems associated with the procedure.
Results:The overall technical and clinical success rates were 88% and 75% respectively. Among the 6 patients with palliative stents, the mean survival time from stent placement to death was 140 days [1-290]. The literature reports a mean duration of patency of approximately 145 days. 50% of the palliative patients did not require any further surgical treatment. One patient died of a possible stent-perforation one day after stent-placement, and two patients underwent emergency surgery due to a persistent colon obstruction. The literature reports a complication rate and re-intervention rate of 25% and 20% respectively
Mean time for progression to surgery after stent placement in the bridge to surgery group was 15 days. The literature reports a mean time of 12 days. 2 of 11 patients underwent emergency surgery due to stent-perforation and stent-obstruction, giving a re-intervention rate of 18%. The literature reports a re-intervention rate of 19%.
Conclusion:Our results are supported by a growing amount of evidence, and suggest that the use of SEMS as management of malignant colorectal obstruction is a safe and effective technique with a low mortality and morbidity rate. Patients with inoperable colorectal cancer can be spared the risks of emergency surgery, and placed as a bridge to surgery, the use of SEMS can lower the morbidity and mortality rate and reduce the need of stoma.