• K J Gorissen, J B Tuynman, E Fryer, L Wang, R Uberoi, O M Jones, C Cunningham, and I Lindsey.
• Departments of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
• Br J Surg. 2013 Dec 1;100(13):1805-9.

BackgroundSelf-expanding metallic stents (SEMS) may be used in acute obstructing left-sided colonic cancers to avoid high-risk emergency surgery. However, oncological safety remains uncertain. This study evaluated the long-term oncological outcome of SEMS as a bridge to elective curative surgery versus emergency resection.MethodsA consecutive prospective cohort of patients admitted with obstructing left-sided colonic cancer between 2006 and 2012 was analysed. The decision to stent as a bridge to surgery or to perform emergency surgery was made by the on-call consultant colorectal surgeon in conjunction with a consultant interventional radiologist; when appropriate, they performed the stent procedure together. Primary outcomes were local and distant recurrence, and overall survival. Secondary outcomes were postoperative complications, in-hospital mortality, proportion of procedures undertaken laparoscopically, and anastomosis and stoma rates.ResultsIn total, 105 patients with obstructing left-sided colonic cancer were treated with curative intent; 62 were treated with SEMS as a bridge to surgery and 43 had emergency resection. In patients aged 75 years or less, stenting and delayed surgery was associated with a higher local recurrence rate compared with emergency surgery at the end of follow-up (32 versus 8 per cent; P = 0·038). This did not translate into a significant difference in overall survival.ConclusionSEMS was associated with an increased local recurrence rate.© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

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