Colonic stenting as a bridge to surgery in malignant colonic obstruction

Upto 80% of patients with colorectal cancer that show up to the emergency room have an obstructive pathology. The use of colonic stenting as a bridge to surgery may resolve the occlusive disorder, allowing the surgeon to do a laparoscopic procedure and safer anastomosis avoiding therefore any stomas. A 65 years old male presented with obstructing sigmoid cancer. A colonic stent was placed, resolved his obstruction and five days later he had an oncological laparoscopic procedure followed by an uneventful recovery. Colonic stenting as a bridge to surgery compared to emergent surgery in obstructing colon cancer decreases definitive stomas, length of hospital stays, anastomotic leakage, early adverse events, and increases primary anastomotic rate. There is no difference in short-term mortality. Use of colonic stent as a bridge to surgery did not showed difference in terms of overall survival, disease free survival, and recurrence.

Surgical treatment strategies for left colon carcinoma with obstruction / 中国实用外科杂志

Left colon carcinoma with obstruction is a tough problem for the department of colorectal surgery to tackle with.It has specific clinical characters and various surgical patterns. Surgical strategies are still in great debate.Conventional three-staged operation and Hartmann operation still have a little value for clinical application. Colonic lavage during the operation combined with one-staged operation can be an important choice for emergency surgeries. As the popularization of colonic stent,selective operation after the insertion of colonic stent is considered to be safe and available. Selective laparoscopic surgery after colonic stent insertion accelerates the rehabilitation of patients and advances their quality of life,which correlates with the theories of minimally invasive surgery and accelerated rehabilitation. However,surgeons are supposed to pay more attention to perforation and relocation caused by colonic stent which may make tumor spread and increase the risk of recurrence. In order to reduce patients' trauma and increase their quality of life as well as long-term prognosis,surgeons need to pursue assistance from multi-disciplinary treatment(MDT) and accomplish an individualized treating project according to patients' condition.

Tratamiento endoscópico del cáncer de colon: revisión de la literatura / Endoscopic treatment of colon cancer: review of the literature

Surgery has long been the only available treatment for colorectal cancer (CRC) even for those detected in early stages. Follow-up studies suggest that endoscopic resection (ER) in carefully selected patients with CRC may be curative. Endoscopic mucosal resection (EMR) in Japan is indicated in the treatment of colorectal adenomas and intramucosal and superficial submucosa CRC commitment, due to the low risk of lymph node metastasis and excellent clinical results. In treating large lesions, tumors of lateral extension, depressed lesions and those with no mark elevation, endoscopic submucosal dissection (ESD) appears as a safe and less invasive alternative, allowing for block resection and also facilitating analysis by the pathologist. In skilled hands, ER may be performed on outpatients obtaining similar results to the surgical treatment, however, a variety of complications have been described, including stricture formation, bleeding and perforations. It is essential to identify those patients who will benefit from endoscopic therapy, carefully evaluating the indications of endoscopic treatment of CRC. A new challenge is to establish a systematic training program for colorectal ESD and to develop improvements in the design of instruments, equipment and solutions for injection to facilitate and increase its use around the world. On the other hand, endoscopy in CRC has a palliative role providing tools for the control of hemorrhage or palliative recanalization of luminal obstruction, including local treatment or colonic stent.

La cirugía ha sido por mucho tiempo el único tratamiento disponible para el cáncer colorrectal (CCR) incluso para aquellos detectados en etapas tempranas. Los estudios de seguimiento sugieren que la resección endoscópica (RE) en pacientes con CCR cuidadosamente seleccionados puede ser curativa. La resección mucosa endoscópica (RME) en Japón está indicada en el tratamiento de adenomas colorrectales y CCR intramucoso y con compromiso de la submucosa superficial debido al escaso riesgo de metástasis ganglionar y a los excelentes resultados clínicos. En el tratamiento de lesiones de mayor tamaño, tumores de extensión lateral, lesiones deprimidas y aquellas con signo de no elevación, la disección endoscópica submucosa (DES) aparece como una alternativa segura, menos invasiva y efectiva que permite la resección en bloque y facilita el análisis por el patólogo. En manos experimentadas, la RE se puede realizar en pacientes ambulatorios, obteniendo resultados similares al tratamiento quirúrgico, sin embargo, una variedad de complicaciones se han descrito, incluyendo la formación de estenosis, hemorragia y perforaciones. Es fundamental identificar aquellos pacientes que se beneficiarán del tratamiento endoscópico, evaluando cuidadosamente las indicaciones de tratamiento endoscópico del CCR. Un nuevo desafío es establecer un programa de entrenamiento sistemático para DES colorrectal, además de desarrollar mejoras en el diseño de los instrumentos, equipamiento y soluciones para inyección para facilitar y aumentar su realización en el mundo. Por otra parte, la endoscopia en CCR tiene un rol paliativo, aportando herramientas para el control de hemorragia o la recanalización paliativa de una obstrucción luminal, que incluye el tratamiento local o la instalación de stent colónicos.

Benefits of Recurrent Colonic Stent Insertion in a Patient with Advanced Gastric Cancer with Carcinomatosis Causing Colonic Obstruction

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival.