Placing the device like a "bridge to surgery" has lowered the incidence of colic stomas and eventually improved the results with respect to patients operated on in emergency settings without placing SEMS.
Unless there is evidence of peritonitis or local perforation we have been using stents in obstructed cases and then operating on them 10-14 days later after completion of staging etc to avoid the need for stomas. A UK trial is underway/possibly completed on the use of stents vs immediate surgery - The CReST Trial
We started two years ago to use SEMS as bridge to surgery. Despite EBM literature is not yet available, waiting for results of ongoing trials, in acute obstructed left colon cancer, we use it. I think that an higher level of attention to the stoma problem, even in case of surgery in emergency setting without SEMS placing, has been useful for us to reduce the two steps surgery of the colon cancer
Long-term follow-up data from recent study favored straight surgery instead of SEMS. It seems that stenting as a bridge to surgery is not oncologically equivalent to immediate surgery.
http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Is_Stenting_as__a_Bridge_to_Surgery__an.98564.aspx?WT.mc_id=HPxADx20100319xMP
The first Dutch study was aborted because of high rate of complications, but other three study are on going. The UK CReST Trial, a second Dutch trial and a swedish trial. I think that we have to wait these results for better understanding the value of the procedure.
- Badges
- Science topic