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World J Gastrointest Surg. Jan 27, 2016; 8(1): 84-89
Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.84
How to decide on stent insertion or surgery in colorectal obstruction?
Assad Zahid, Christopher John Young
Assad Zahid, Christopher John Young, Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
Assad Zahid, Christopher John Young, Discipline of Surgery, University of Sydney, Sydney, NSW 2006, Australia
Christopher John Young, RPAH Medical Centre, Newtown, Sydney, NSW 2042, Australia
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christopher John Young, MBBS, MS, FRACS, FACS, Clinical Associate Professor, RPAH Medical Centre, Suite 415/100 Carillon Ave, Newtown, Sydney, NSW 2110, Australia. cyoungnsw@aol.com
Telephone: +61-2-95153204 Fax: +61-2-95153222
Received: June 30, 2015
Peer-review started: July 5, 2015
First decision: October 13, 2015
Revised: November 6, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: January 27, 2016
Processing time: 205 Days and 2.5 Hours
Abstract

Colorectal cancer is one of the most common cancers in western society and malignant obstruction of the colon accounts for 8%-29% of all large bowel obstructions. Conventional treatment of these patients with malignant obstruction requiring urgent surgery is associated with a greater physiological insult on already nutritionally replete patients. Of late the utility of colonic stents has offered an option in the management of these patients in both the palliative and bridge to surgery setting. This has been the subject of many reviews which highlight its efficacy, particulary in reducing ostomy rates, allowing quicker return to oral diet, minimising extended post-operative recovery as well as some quality of life benefits. The uncertainity in managing patients with malignant colonic obstructions has lead to a more cautious use of stenting technology as community equipoise exists. Decision making analysis has demonstrated that surgeons’ favored the use of stents in the palliative setting preferentially when compared to the curative setting where surgery was preferred. We aim to review the literature regarding the use of stent or surgery in colorectal obstruction, and then provide a discourse with regards to the approach in synthesising the data and applying it when deciding the appropriate application of stent or surgery in colorectal obstruction.

Keywords: Self-expanding metallic stent; Stenting; Surgery; Colorectal cancer; Large bowel obstruction; Radiology

Core tip: Despite the accumulation of data on stent insertion, the choice of stent or surgery as the most appropriate modality in the management of colorectal obstruction presents a constant decision dilemma. When cure is possible we want that, but with minimal morbidity. In a group of patients who are prone to higher rates of morbidity and mortality, this can be problematic and full of uncertainty. This review takes an approach to review the primary and secondary outcomes established in the literature regarding the use of stent or surgery in colorectal obstruction, and then create discourse and a structured approach in regards to synthesising the data and applying it when deciding the appropriate application of stent or surgery in colorectal obstruction.