The impact of stenting obstructing colorectal tumours in a district general hospital

IntroductionThe technique of stenting malignant obstructing colorectal lesions is established as an acceptable treatment with a low morbidity and mortality. This paper reviews our experience in stenting malignant colorectal obstruction and compares this group with those who underwent emergency surgery as their primary intervention.MethodsA retrospectively kept database over four years was reviewed and patients who had undergone either stenting or emergency surgery for a malignant colorectal obstruction were identified. These patients’ notes were retrieved and reviewed.ResultsDuring the duration of study, a total of 29 stents were placed in 28 patients, with a mean age of 78 y (range 59–96 years). Patients generally had significant co-existing morbidity, with a median ASA score of 2.5. The timing of stent placement was a mean of 3.4 days (1–9 days) after presentation, including time for relevant investigation and diagnosis. Mean length of hospital stay was 9.8 days (2–36 days). In the emergency operation category, during the period of study, a total of 38 patients had operations for large bowel obstruction, either because the lesion was not suitable for stenting, or the personnel for stenting were not available. These patients ranged in age from 45 to 96 years, with a mean age of 72.4 years. Patients in this group were generally a little fitter than the stented group, with a median ASA grade of 2, and 14/38 patients were ASA1 (the largest group). Despite this Post-operative recovery was slow with these patients, the average length of stay being 16 days (range 8–66 days).ConclusionsIn this study, we report our data on the first four years of stenting malignant bowel obstruction. It is a feasible and acceptable means of treatment, and we have demonstrated comparable morbidity and mortality to that reported in medical literature. The technique may avoid the need for emergency operation with its concomitant risks, lengthy in-patient stay, and high likelihood for a stoma. We would advocate the use of self expanding metal stents where appropriate in the management of large bowel obstruction.