Outcome and complications of stenting for malignant obstruction

Malignant colorectal obstruction is not an uncommon clinical condition as it is frequently cited that obstruction occurs in 7%-29% of patients with colorectal cancer. The severity of this condition is illustrated by its high postoperative mortality (up to 24%) and morbidity (up to 78%) rates after these patients have undergone conventional emergency resection of the obstructing tumor. In the past decade, the application of self-expandable metal stents (SEMSs) as treatment of malignant large bowel obstruction has expanded rapidly to reduce these alarming numbers by ‘bridge to surgery’ treatment from an emergency to an elective operation. However, the randomized controlled trials published on this topic show conflicting results regarding the outcome of SEMS placement as a bridge to surgery. Recently, a number of meta-analyses have been published on the outcomes of SEMS placement as bridge to surgery compared with emergency surgery, and data are also developing on the long-term oncological consequences of preoperative SEMS placement in the curative setting of malignant large bowel obstruction. Therefore, this review provides an overview of the current evidence on the use of SEMSs in the treatment of malignant large bowel obstruction.