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June 2010

Stenting or Not Stenting Before Operating Malignant Colonic Obstruction? That Is the Question

Author Affiliations

Author Affiliations: Department of Digestive Surgery University Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France (Dr Slim); and Department of Digestive Surgery, Saint-Eloi Hospital, Montpellier, France (Drs Pirlet and Millat).

Arch Surg. 2010;145(6):601. doi:10.1001/archsurg.2010.86

We read with interest the article by Cheung et al1 published in the December 2009 issue of the Archives. First, we congratulate them for the completion of their randomized trial comparing stents with emergency surgery for obstructing left-sided colon cancer, because we all know how difficult it is to conduct such a trial in an emergency setting while comparing 2 very different approaches. Their results regarding the success rate of stents are impressive, though we in France have not had the same experience. Our results of stenting are far less favorable than those of the authors. We have conducted a quite similar randomized trial (I.P. et al, unpublished data, 2010), including 60 patients on an intent-to-treat basis (30 in each group), with stoma for any reason as the main end point. A total of 17 patients (57%) sustained a stoma after emergent open surgery compared with 13 (43%) patients after stenting and subsequent surgery (P = .30). Most stoma (n = 12) in the stenting group were placed because of failure or complications of the procedure. Hence, in our experience, stenting did not meet its goal by avoiding the stoma in nearly half of our patients.

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