Annals of Coloproctology

Original Articles

Colorectal cancer

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution: Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(6):555-563. Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00738.0105

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Abstract PDF: Purpose
In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution’s experiences.
Methods
Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.
Results
Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.
Conclusion
Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

Colorectal cancer

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia: Cian Keogh, Julie Moore, Danica Cossio, Nick Smith, David A. Clark; Ann Coloproctol. 2024;40(3):268-275. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00640.0091

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Abstract PDF: Purpose
Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes.
Methods
Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates.
Results
In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma.
Conclusion
Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

Technical Note

Technical tip

Endoscopic transstomal stent insertion: a novel approach for a stenosed stoma in a challenging patient: Feras Aljarad, Ashutosh Gumber, Anne Marie McLeary, Kawan Shalli; Ann Coloproctol. 2023;39(4):357-361. Published online February 9, 2023; DOI: https://doi.org/10.3393/ac.2022.00962.0137

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Abstract PDF

Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.

Citations

Citations to this article as recorded by

Application of a novel two-piece pouch in postoperative enterostomy in miniature Parma pigs
Yingjie Liu, Caiyan Xue, Jianyuan Wan, Meijiao Lin
Asian Journal of Surgery.2025; 48(3): 1866. CrossRef
The Stomal Stent: A Novel Bridging Therapy for Patients Requiring Delayed Ostomy Revision
Mason Henrich, Bianca Fischer, Jun Tashiro
The American Surgeon™.2025; 91(4): 653. CrossRef

Case Report

Benign bowel disease

A case report of a colouterine fistula treatment: when the patient chooses the steeplechase: Stefano Pontone, Pier Giorgio Nardis, Chiara Eberspacher, Domenico Mascagni; Ann Coloproctol. 2023;39(4):366-370. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00318.0045

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Abstract PDF: Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.

Original Articles

Malignant disease,Prognosis and adjuvant therapy,Colorectal cancer

Comparison of the oncological outcomes of stenting as a bridge to surgery and surgery alone in stages II to III obstructive colorectal cancer: a retrospective study: Hiroaki Uehara, Toshiyuki Yamazaki, Akira Iwaya, Hitoshi Kameyama, Masaru Komatsu, Motoharu Hirai; Ann Coloproctol. 2022;38(3):235-243. Published online July 13, 2021; DOI: https://doi.org/10.3393/ac.2020.01067.0152

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11 Citations

Graphical Abstract Abstract PDF

Purpose
We evaluated the oncological outcomes of bridge to surgery (BTS) using stent compared with surgery alone for obstructive colorectal cancer.
Methods
Consecutive patients who underwent curative resection for stages II to III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the 2 groups.
Results
Stent-related perforation did not occur. One patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression (clinical success rate, 97.7%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group; nonemergency surgery (P<0.001), surgical approach (P=0.006), and length of hospital stay (P=0.020). The median follow-up time was 44.9 months (range, 1.1–126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P=0.411), and the overall survival rates were 78.3% and 88.2% (P=0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P=0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P=0.035) in the surgery alone and BTS groups, respectively.
Conclusion
This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II to III obstructive colorectal cancer potentially worsens oncological outcomes.

Citations

Citations to this article as recorded by

Controversial issues of colon stenting in case of tumor obstructive intestinal obstruction: surgical and oncological aspects
S.A. Aliyev, E.S. Aliyev, T.K. Aliyev
Endoscopic Surgery.2025; 31(2): 65. CrossRef
Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis
Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari
Clinical Endoscopy.2025; 58(2): 240. CrossRef
A rare case of massive colonic distention secondary to undiagnosed colon adenocarcinoma
Chloe Lahoud, Toni Habib, Michel Al Achkar, Tyler Grantham, Nissar Ahmed
Medical Reports.2025; 12: 100207. CrossRef
Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis
Soo Young Oh, Chan Wook Kim, Seonok Kim, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(2): 135. CrossRef
Can we use colon stenting in accelerated recovery programs for surgical treatment colon cancer complicated by obstructive intestinal obstruction? A literature review
Saday A. Aliyev, Emil S. Aliyev
Russian Journal of Oncology.2024; 29(2): 130. CrossRef
Oncologic impact of colonic stents for obstructive left-sided colon cancer
Hideyuki Suzuki, Shingo Tsujinaka, Yoshihiro Sato, Tomoya Miura, Chikashi Shibata
World Journal of Clinical Oncology.2023; 14(1): 1. CrossRef
5-year oncological outcomes in left-sided malignant colonic obstruction: stent as bridge to surgery
Noura S Alhassan, Sulaiman A AlShammari, Razan N AlRabah, Amirah M AlZahrani, Maha-Hamadien Abdulla, Thamer A Bin Traiki, Ahmad M Zubaidi, Omar A Al-Obeed, Khayal A Alkhayal
BMC Gastroenterology.2023;[Epub] CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach
Ji-Hyun Seo, In-Ja Park
Cancers.2023; 15(21): 5211. CrossRef
Recurrence Patterns and Risk Factors after Curative Resection for Colorectal Cancer: Insights for Postoperative Surveillance Strategies
Hyo Seon Ryu, Jin Kim, Ye Ryung Park, Eun Hae Cho, Jeong Min Choo, Ji-Seon Kim, Se-Jin Baek, Jung-Myun Kwak
Cancers.2023; 15(24): 5791. CrossRef
Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020
Margherita Binetti, Augusto Lauro, Valeria Tonini
World Journal of Clinical Oncology.2022; 13(12): 957. CrossRef

Malignant disease, Rectal cancer,Colorectal cancer,Biomarker & risk factor

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Obstructing Colorectal Cancer Treated by Endoscopic Stenting as a Bridge to Surgery: Jiwei Guo, Aik Yong Chok, Hui Jun Lim, Wei Xuan Tay, Weng Kit Lye, Lasitha Bhagya Samarakoon, Emile John Tan, Ronnie Mathew; Ann Coloproctol. 2021;37(3):159-165. Published online May 28, 2021; DOI: https://doi.org/10.3393/ac.2020.05.25

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Abstract PDF Supplementary Material

Purpose
Neutrophil-to-lymphocyte ratio (NLR) has been reported to predict adverse survival outcomes among patients with colorectal cancer (CRC). This study evaluates the prognostic value of NLR among patients with obstructing CRC who successfully underwent stenting before curative surgery.
Methods
We retrospectively reviewed patients who underwent stenting before surgery. Patient demographics, tumor characteristics, perioperative outcomes, recurrence-free survival (RFS), and overall survival (OS) were analyzed. NLR was calculated from the differential white blood cell counts at least 4 days after successful stenting, before elective surgery. Optimal cutoff to dichotomize NLR was obtained by maximizing log-rank test statistic with recursive partitioning of KaplanMeier RFS and OS curves. The optimal cutoff for high NLR was ≥ 5 at presentation before stenting, and ≥ 4 after stenting.
Results
Fifty-seven patients with localized obstructing CRC underwent successful endoscopic stenting before curative surgery. High NLR was associated with lymphovascular invasion (P = 0.006) and apical lymph node involvement (P = 0.034). Major perioperative complication(s) (hazard ratio [HR], 11.34; 95% confidence interval [CI], 2.49 to 51.56; P < 0.01) and high NLR (HR, 3.69; 95% CI, 1.46 to 9.35; P < 0.01) negatively impacted OS on univariate and multivariate analyses. High NLR negatively impacted RFS on univariate analysis (HR, 2.91; 95% CI, 1.29 to 6.60; P = 0.01).
Conclusion
NLR of ≥ 4 after stenting is an independent prognostic factor among patients with obstructing localized CRC who are successfully decompressed by endoscopic stenting before curative surgery.

Citations

Citations to this article as recorded by

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Inflammatory Response Markers as Predictors of Colorectal Cancer Prognosis
Minsung Kim, Il Tae Son, Bo Young Oh
The Ewha Medical Journal.2023;[Epub] CrossRef
Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef

Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting: Chung Ki Min, Hyung Ook Kim, Donghyoun Lee, Kyung Uk Jung, Sung Ryol Lee, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2016;32(6):215-220. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.215

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Abstract PDF

Purpose

This study compared a subtotal colectomy to self-expandable metallic stent (SEMS) insertion as a bridge to surgery for patients with left colon-cancer obstruction.

Methods

Ninety-four consecutive patients with left colon-cancer obstruction underwent an emergency subtotal colectomy or elective SEMS insertion between January 2007 and August 2014. Using prospectively collected data, we performed a retrospective comparative analysis on an intention-to-treat basis.

Results

A subtotal colectomy and SEMS insertion were attempted in 24 and 70 patients, respectively. SEMS insertion technically failed in 5 patients (7.1%). The mean age and rate of obstruction in the descending colon were higher in the subtotal colectomy group than the SEMS group. Sex, underlying disease, American Society of Anesthesiologists physical status, and pathological stage showed no statistical difference. Laparoscopic surgery was performed more frequently in patients in the SEMS group (62 of 70, 88.6%) than in patients in the subtotal colectomy group (4 of 24, 16.7%). The overall rate of postoperative morbidity was higher in the SEMS group. No Clavien-Dindo grade III or IV complications occurred in the subtotal colectomy group, but 2 patients (2.9%) died from septic complications in the SEMS group. One patient (4.2%) in the subtotal colectomy group had synchronous cancer. The total hospital stay was shorter in the subtotal colectomy group. The median number of bowel movements in the subtotal colectomy group was twice per day at postoperative 3–6 months.

Conclusion

A subtotal colectomy for patients with obstructive left-colon cancer is a clinically and oncologically safer, 1-stage, surgical strategy compared to SEMS insertion as a bridge to surgery.

Citations

Citations to this article as recorded by

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution
Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan
Annals of Coloproctology.2024; 40(6): 555. CrossRef
Short- and long-term outcomes of subtotal/total colectomy in the management of obstructive left colon cancer
Jung Tak Son, Yong Bog Kim, Hyung Ook Kim, Chungki Min, Yongjun Park, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim
Annals of Coloproctology.2023; 39(3): 260. CrossRef
Outcomes After Colonic Self-Expanding Metal Stent Insertion Without Fluoroscopy: A Surgeon-Led 10-Year Experience
Tara M. Connelly, Jessica Ryan, Niamh M. Foley, Helen Earley, Shaheel M. Sahebally, Carl O'Brien, Peter McCullough, Peter Neary, Fiachra Cooke
Journal of Surgical Research.2023; 281: 275. CrossRef
Which treatment strategy is optimal for acute left-sided malignant colonic obstruction? A Bayesian meta-analysis
Kaibo Ouyang, Zifeng Yang, Yuesheng Yang, Junjiang Wang, Deqing Wu, Yong Li
International Journal of Colorectal Disease.2023;[Epub] CrossRef
New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic
Dragos Serban, Geta Vancea, Catalin Gabriel Smarandache, Simona Andreea Balasescu, Gabriel Andrei Gangura, Daniel Ovidiu Costea, Mihail Silviu Tudosie, Corneliu Tudor, Dan Dumitrescu, Ana Maria Dascalu, Ciprian Tanasescu, Laura Carina Tribus
Applied Sciences.2022; 12(11): 5337. CrossRef
Functional outcomes of surgery for colon cancer: A systematic review and meta-analysis
Sanne J. Verkuijl, Jara E. Jonker, Monika Trzpis, Johannes G.M. Burgerhof, Paul M.A. Broens, Edgar J.B. Furnée
European Journal of Surgical Oncology.2021; 47(5): 960. CrossRef
Short-term outcomes of stents in obstructive rectal cancer
Nora H. Trabulsi, Hajar M. Halawani, Esraa A. Alshahrani, Rawan M. Alamoudi, Sama K. Jambi, Nouf Y. Akeel, Ali H. Farsi, Mohammed O. Nassif, Ali A. Samkari, Abdulaziz M. Saleem, Nadim H. Malibary, Mohammad M. Abbas, Luca Gianotti, Antonietta Lamazza, Jin
Saudi Journal of Gastroenterology.2021; 27(3): 127. CrossRef
Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon
Fan Xue, Feng Lin, Jun Zhou, Ning Feng, You-Gang Cui, Xu Zhang, Yu-Peng Yi, Wen-Zhi Liu
Emergency Medicine International.2020; 2020: 1. CrossRef
Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation
Eun-Do Kim, Jin-Kwon Lee, Jin-Kyu Cho, Jae-Myung Kim, Ji-Ho Park, Ju-Yeon Kim, Sang-Ho Jeong, Young-Tae Ju, Chi-Young Jeong, Eun-Jung Jung, Young-Joon Lee, Soon-Chan Hong, Seung-Jin Kwag
Korean Journal of Clinical Oncology.2019; 15(2): 106. CrossRef
Laparoscopic assisted insertion of a colonic self-expandable metallic stent
Y. M. Ho, V. Shenoy, J. Alberts, N. Ward
Techniques in Coloproctology.2018; 22(10): 809. CrossRef

Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer: Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim; J Korean Soc Coloproctol. 2012;28(1):35-41. Published online February 29, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.1.35

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Abstract PDF

Purpose

The aim of this study was to compare survival in patients that underwent palliative resection treatment versus non-resection for incurable colorectal cancer (ICRC).

Methods

The case records of 201 patients with ICRC between January 2000 and December 2009 were reviewed. Demographics, American Society of Anesthesiologists (ASA) score, carcinoembryonic antigen (CEA) level, the location of the colon cancer, histology, metastasis, treatment options and median survival were analyzed retrospectively. We divided the patients into four groups according to the treatment modalities: resection alone, resection with post-operative chemotherapy, non-resection treatment by chemotherapy alone, and stent or bypass. Median survival times were compared according to each treatment option, and the survival rates were analyzed.

Results

105 patients underwent palliative resection whereas 96 were treated with non-resection modalities. A palliative resection was performed in 44 cases for resection alone and in 61 cases for resection with post-operative chemotherapy. In patients treated with non-resection of the primary tumor, chemotherapy alone was done in 65 cases and stent or bypass in 31 cases. Multivariate analysis showed a median survival of 14 months in patients with palliative resections with post-operative chemotherapy, which was significantly higher than those for chemotherapy alone (8 months), primary tumor resection alone (5 months), and stent or bypass (5 months). Gender, age, ASA score, CEA level, the location of colon cancer, histology and the presence of multiple metastases were not independent factors in association with the median survival rate.

Conclusion

In the treatment of ICRC, palliative resection followed by post-operative chemotherapy shows the most favorable median survival compared to other treatment options.

Citations

Citations to this article as recorded by

Incidence and determinants of mortality among patients with colorectal cancer in oncology centers of Amhara region, Ethiopia, 2024: multicenter retrospective follow up study
Getachew Tesfaw Walle, Tegene Atamenta Kitaw, Seteamlak Adane
BMC Cancer.2025;[Epub] CrossRef
Biopsy sampling during self-expandable metallic stent placement in acute malignant colorectal obstruction: a narrative review
Sigrid Skov Bennedsgaard, Lene Hjerrild Iversen
World Journal of Surgical Oncology.2021;[Epub] CrossRef
National statistics about resection of the primary tumor in asymptomatic patients with Stage IV colorectal cancer and unresectable metastases. Need for improvement in data collection. A systematic review with meta-analysis
Antonio V. Sterpetti, Umberto Costi, Giuseppe D'Ermo
Surgical Oncology.2020; 33: 11. CrossRef
Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta‐analysis
Constantinos Simillis, Eliana Kalakouti, Thalia Afxentiou, Christos Kontovounisios, Jason J. Smith, David Cunningham, Michel Adamina, Paris P. Tekkis
World Journal of Surgery.2019; 43(7): 1829. CrossRef
Long-Chain Noncoding RNAPVT1Gene Polymorphisms Are Associated with the Risk and Prognosis of Colorectal Cancer in the Han Chinese Population
Lei Zhang, Jiehong Mao
Genetic Testing and Molecular Biomarkers.2019; 23(10): 728. CrossRef
Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer
U Nitsche, C Stöß, L Stecher, D Wilhelm, H Friess, G O Ceyhan
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A systematic analysis highlighting deficiencies in reported outcomes for patients with stage IV colorectal cancer undergoing palliative resection of the primary tumour
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European Journal of Surgical Oncology.2018; 44(10): 1469. CrossRef
Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage IV colorectal cancer in the era of modern systemic chemotherapy
Gi Won Ha, Jong Hun Kim, Min Ro Lee
Annals of Surgical Treatment and Research.2018; 95(2): 64. CrossRef
Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients
Heui-June Ahn, Ho-Suk Oh, Yongchel Ahn, Sang Jin Lee, Hyun Joong Kim, Moon Ho Kim, Dae-Woon Eom, Jae Young Kwak, Myoung Sik Han, Jae Seok Song
Annals of Coloproctology.2014; 30(4): 175. CrossRef
A Meta-Analysis to Determine the Effect of Primary Tumor Resection for Stage IV Colorectal Cancer with Unresectable Metastases on Patient Survival
Cillian Clancy, John P. Burke, Mitchel Barry, Matthew F. Kalady, J. Calvin Coffey
Annals of Surgical Oncology.2014; 21(12): 3900. CrossRef
Palliative laparoscopic bowel resection in stage IV colorectal cancer patients with unresectable metastasis
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Recent Advances in the Management of Stage IV Colon Cancer
Rani Kanthan, Jenna-Lynn Senger, Shahid Ahmed, Selliah Kanthan
Journal of Cancer Therapy.2012; 03(06): 1104. CrossRef
Kolonstents als «Bridge to Surgery»
Karl E. Grund, Annette Zipfel
Visceral Medicine.2012; 28(6): 412. CrossRef
Review and Evaluation of Methods Correcting for Population Stratification with a Focus on Underlying Statistical Principles
Hemant K. Tiwari, Jill Barnholtz-Sloan, Nathan Wineinger, Miguel A. Padilla, Laura K. Vaughan, David B. Allison
Human Heredity.2008; 66(2): 67. CrossRef

Comparison of Self-Expanding Metallic Stenting with Emergency Surgery as First-Management for Obstructing Primary Left-sided Colorectal Cancer.: Park, Ji Won , Lee, Min Ro , Hong, Chang Won , Yoon, Sang Nam , Park, Hyoung Chul , Kim, Se Hyung , Han, Joon Koo , Park, Kyu Joo , Park, Jae Gahb; J Korean Soc Coloproctol. 2006;22(1):41-46.

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Abstract PDF: PURPOSE
Emergency surgery has been a conventional treatment for malignant large-bowel obstruction, but is associated with high morbidity and mortality. Recently, self-expanding metallic stents (SEMS) have provided a new modality as palliation or bridge therapy for patients with obstructing colorectal cancers. The purpose of the present study is to evaluate whether SEMS is useful in patients with malignant large bowel obstruction.
METHODS
Between January 1999 and June 2004, 63 patients were treated for primary obstructing left-side colorectal cancer at the Department of Surgery, Seoul National University Hospital. 32 patients were managed firstly with SEMS (stent group), and 31 patients underwent an emergency operation (emergency surgery group). Clinical data were retrospectively reviewed. The results, including perioperative outcome and survival, were compared between the two groups.
RESULTS
Clinicopathological parameters, including age, gender, ASA grade, tumor location and stage, were similar between the two groups. The rate of one-stage operations was significantly higher in the stent group (52% vs 13%; P=0.004). The stent group was associated with a lower rate of stoma formation (48% vs 87%; P=0.004), a shorter length of hospital stay (19 days vs 26 days; P=0.048), and fewer complications (7% vs 30%; P= 0.035). The overall and the disease-free survival rates were similar between the two groups (P=0.973, 0.126). The stent group was associated with fewer surgeries needed, shorter length of hospital stay, and fewer complications.
CONCLUSIONS
Stenting with SEMS is useful in managing malignant large-bowel cancer with obstruction and may be better than traditional open surgery.

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