To compare the clinical effect of self-expanding metal stents as a bridge to surgery (the SEMS group) with those of emergency surgery (the ES group) for malignant colorectal obstruction (MCO).

A retrospective analysis was made on the 60 cases of MCO that received surgical treatment in Changhai Hospital of the Second Military Medical University and No. 413 Hospital from October 2007 to December 2012. The SEMS group(27 cases)received self-expanding metal stents, while the ES group (33 cases) was treated with emergency surgery. Indexes, such as primary anastomotic rate, stoma rate, laparoscopic surgical rate, death rate after surgery, postoperative complication rate, ICU transfer rate, the number of lymph nodes cleared, surgical time, length of hospital stay and hospitalization cost, were compared between the 2 groups. Before surgery, the medical team consisting of multidisciplinary specialists held discussions on the treatment schemes and appropriate surgical protocols were developed pertaining to individual cases.

Primary anastomotic rate of the patients in the SEMS group (92.6%, 25/27)was significantly higher than that of the patients in the ES group (66.7%, 22/33)(P=0.015). Stoma rate of the SEMS group (7.4%, 2/27)was significantly lower than that of the ES group (45.5%, 15/33)(P=0.001). Laparoscopic surgical rate of the SEMS group (14.8%, 4/27)was obviously higher than that of the ES group (0%, 0/33)(P=0.035). ICU transfer rate of the SEMS group (7.4%, 2/27)was significantly lower than that of the ES group (33.3%, 11/33)(P=0.015). The number of lymph nodes cleared for the SEMS group(17.52±4.00)was larger than that for the ES group (13.73±6.12) (P=0.008). Surgical time for the SEMS group (117.22±6.42) min was significantly shorter than that for the ES group (173.64±8.32) min (P<0.01). Length of hospital stay for the SEMS group (9 d) was significantly shorter than that for the ES group (14 d) (P<0.01). The median hospitalization cost for the SEMS group (39183.33 RMB) was significantly less than that for the ES group (53675.58 RMB) (P<0.01). Death rate 30 days after surgery and complication rate during perioperative period for the SEMS group [(0%, 0/27), (7.4%, 2/27)] were lower than those for the ES group [(3.0%, 1/33), (21.2%, (7/33)], and no statistical significance could be noted when comparisons were made between them (P<0.05). The postoperative morbidity in the SEMS group was lower than that in the ES group (3.0% vs 21.2%), without significant statistical difference (P<0.05).

SEMS could effectively relieve the obstruction caused by colorectal cancer, and change the traditional emergency surgery into a selective surgery with better outcomes. This technique could offer better chances for medical transfer at sea or medical transformation to higher echelon care and seemed to have good promise for further clinical application.

Stent; Emergency surgery; Bowel obstruction; Colorectal cancer