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Invited Critique
December 21, 2009

Does Every Question Deserve a Randomized Controlled Trial?Comment on “Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer: A Randomized Controlled Trial”

Arch Surg. 2009;144(12):1132. doi:10.1001/archsurg.2009.217

Despite the fact that the quality of the available evidence on use of colonic stents as a bridge to surgery for patients with obstructing left colon tumors might be considered relatively poor, systematic review shows that the median technical success rate (appropriate placement of the stent) and the median clinical success rate (resolution of obstruction) are both greater than 90%, with a median short-term perforation rate of less than 5%. Decompression provides time for staging, resuscitation, bowel preparation, and safe, elective resection. The rate of primary anastomosis is twice that following emergent surgery and the stoma rate is significantly reduced. Morbidity and mortality rates for emergent operation in this setting range from 45% to 50% and 15% to 20%, respectively. In addition, in about half the cases, when emergent treatment involves a stoma, it is never reversed.

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