Expandable metal stents in malignant colorectal obstruction

There are an estimated 300 000 new cases of colorectal cancer detected in Europe and the United States each year; 7-29% of these cases present with complete or partial obstruction of the large bowel. 1 2 Patients who present with obstruction have a five year survival rate of less than 20%, a far poorer prognosis than patients who present without obstruction.2 This poor outlook reflects not only the more advanced stage of carcinomas that cause obstruction — 40% of these patients have metastatic disease at presentation—but also the greater risks associated with emergency decompressive surgery in elderly people.3 Despite the increasing popularity of primary resection and anastomosis, most surgeons still advocate the traditional two stage procedure which creates a temporary stoma. In patients found to have advanced disease this stoma is likely to become permanent. Only about 20% of these patients will survive for one year after this palliative surgery.2 For patients with “curable” disease there is the option of elective re-anastomosis. Many elderly patients and their surgeons are deterred from the second closure operation because it can lead to morbidity or death; thus …