Colonic stenting as a bridge to surgery in malignant colonic obstruction

Ortiz de Elguea-Lizarraga J. I., Alberto Riojas-Garza, Alberto Chapa-Lobo, Mario Rodarte-Shade, Hugo Rangel-Rios, Luis Enrique Salgado-Cruz


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.


Colonic stent, Colorectal cancer obstruction, Stenting as a bridge to surgery

Full Text:



Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, et al (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD. Available at, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, et al. WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emergency Surg. 2018;13(1).

Kones O, Kartal A, Akarsu M, Akarsu C, Gunes M, Alis EH. Colonic Stent Use in Patients with Malignant Flexure Tumors Presenting with Obstruction. JSLS: J Society Laparoendoscopic Surg. 2019;23(1).

Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD. The Association of Coloproctology of Great Britain and Ireland Study of Large Bowel Obstruction Caused by Colorectal Cancer. Annals Surg. 2004;240(1):76-81.

Tejero E, Mainar A, Fernandez L, Tieso A, Cuezva JF, Jose AS. New procedure for relief of malignant obstruction of the left colon. British J Surg. 1995;82(1):34-5.

Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP. The SCARE 2018 Statement: Updating Consensus Surgical case report (SCARE) Guidelines. Int J Surg. 2018;60:132-6.

Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP. The process 2018 Statement: updating consensus preferred reporting of case series in surgery (process) guidelines. Int J Surg. 2018;60:279-82.

Mir CA, Marcos RJM, Serralvo LADL, Abadia DC, Rodenas CJA. Impact on Surgical and Oncological Results of the Use of Colonic Stents as a Bridge to Surgery for Potentially Curable Occlusive Colorectal Neoplasms. Cirugia Espanola (English Edition). 2018;96(7):419-28.

Huang X, Lv B, Zhang S, Meng L. Pre-operative Colonic Stents Versus Emergency Surgery for Acute Left-Sided Malignant Colonic Obstruction: A Meta-analysis. J Gastrointestinal Surg. 2013;18(3):584-91.

Arezzo A, Passera R, Secco GL, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy. 2017;86(3):416-26.

Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L. Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis. Int J Surg Oncology. 2017:1-11.

Ribeiro I, Bernardo W, Martins B, Moura DD, Baba E, Josino I, et al. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endoscopy Int Open. 2018;6(5).

Amelung FJ, Burghgraef TA, Tanis PJ, Hooft JEV, Borg FT, Siersema PD, et al. Critical appraisal of oncological safety of stent as bridge to surgery in left-sided obstructing colon cancer; a systematic review and meta-analysis. Critical Reviews Oncology Hematology. 2018;131:66-75.

Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endoscopy. 2011;26(1):110-9.

Halsema EEV, Hooft JEV, Small AJ, Baron TH, Cano GJ, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointestinal Endoscopy. 2014;79(6).

Hooft JV. Colonic stenting or surgery in left sided colonic obstruction for disseminated incurable colorectal cancer: a multicenter randomised trial. World J Gastroenterol. 2012;18(39):5608-15.

Park YE, Park Y, Park SJ, Cheon JH, Kim WH, Kim TI. Outcomes of stent insertion and mortality in obstructive stage IV colorectal cancer patients through 10 years duration. Surg Endoscopy. 2018;33(4):1225-34.

Foo CC, Poon SHT, Chiu RHY, Lam WY, Cheung LC, Law WL. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endoscopy. 2018;33(1):293-302.

Avlund TH, Erichsen R, Ravn S, Ciplys Z, Andersen JC, Laurberg S, Iversen LH. The prognostic impact of bowel perforation following self-expanding metal stent as a bridge to surgery in colorectal cancer obstruction. Surg Endoscopy. 2017;32(1):328-36.

Kang SI, Oh HK, Yoo JS, Ahn S, Kim MH, Kim MJ, et al. Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer. Surg Oncology. 2018;27(2):216-24.

Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, et al. Comparison of Long-Term Outcomes of Colonic Stent as “Bridge to Surgery” and Emergency Surgery for Malignant Large-Bowel Obstruction: A Meta-Analysis. Annals Surg Oncology. 2014;22(2):497-504.

Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M, et al. Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointestinal Oncology. 2017;8(5):867-76.