Transtumoral endoprothesis in surgery of colorectal cancer, complicated with colonic obstruction: advantages and disadvantages. A review of the literature

A multifactorial analysis of the literature data on the treatment of acute tumor colonic obstruction using minimally invasive endoscopic surgical technology was carried out. On the basis of the analysis of special publications, the effectiveness of stenting of the large intestine, as a minimally invasive endoscopic method of decompression, is presented. Indications and contraindications for colorectal stenting, advantages and disadvantages, possibilities and prospects of endoscopic decompression of the colon are described in detail. It is postulated that stenting, used in acute tumor obstruction of the colon as a «bridge to surgery», being a worthy alternative to classical colostomy, allows an effective antegrade decompression of the colon and prepares the patient to surgical treatment with the performance of oncological justified primary radical and one-stage restorative operations in more optimal conditions with minimal risk. It is shown that in the late stages of the malignant process and in the presence of neresect-leucorrhoea colorectal cancer, as well as in the presence of absolute contraindications to a radical surgeon Colon stenting can serve as the final treatment for inoperable patients.

Management of Acute Anastomotic Leaks

Management of the acute anastomotic leak is complex and patient-specific. Clinically stable patients often benefit from a nonoperative approach utilizing antibiotics with or without percutaneous drainage. Clinically unstable patients or nonresponders to conservative management require operative intervention. Surgical management is dictated by the degree of contamination and inflammation but includes drainage with proximal diversion, anastomotic resection with end-stoma creation, or reanastomosis with proximal diversion. Newer therapies, including colorectal stenting, vacuum-assisted rectal drainage, and endoscopic clipping, have also been described.

Colorectal stenting in England: a cross-sectional study of practice

Introduction UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. Methods All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). Results Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. Conclusions All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.