Stenting for Obstructing Colon Cancer: Fewer Complications and Colostomies

Background and Objectives: Colonic stenting has been used in the setting of malignant obstruction to avoid an emergent colectomy. We sought to determine whether preoperative placement of a colonic stent decreases mor-bidity and the rate of colostomy formation. Methods: Cases of obstructing sigmoid, rectosigmoid, and rectal cancer from January 1, 2010, to December 31, 2011, were identified in the Nationwide Inpatient Sample (NIS) database. All patients were treated at hospitals in the United States, and the database generated national esti-mates. Postoperative complications, mortality, and the rate of colostomy formation were analyzed. Results: Of the estimated 7891 patients who presented with obstructing sigmoid, rectosigmoid, or rectal cancer necessitating intervention, 12.1 % (n 956) underwent placement of a colonic stent, and the remainder under-went surgery without stent placement. Of the patients who underwent stenting, 19.9 % went on to have colon resection or stoma creation during the same admission. Patients who underwent preoperative colonic stent place-ment had a lower rate of total postoperative complications (10.5 % vs 21.7%; P .01). There was no significant dif-ference in mortality (4.7 % vs 4.2%; P .69). The rate of colostomy formation was more than 2-fold higher in pa-tients who did not undergo preoperative stenting (42.5% vs 19.5%; P .01). Preoperative stenting was associated with increased use of laparoscopy (32.6 % vs 9.7%; P .01). Conclusions: Our study characterizes the national inci-dence of preoperative placement of a colonic stent in the setting of malignant obstruction. Preoperative stent place-ment is associated with lower postoperative complications and a lower rate of colostomy formation. The results support the hypothesis that stenting as a bridge to surgery may benefit patients by converting an emergent surgery into an elective one. Key Words: Colonic obstruction, Malignant bowel ob-struction, Obstructing colon cancer