Endoscopic Stenting at the Stages of Radical and Palliative Treatment in Patients with Obstructive Colorectal Cancer: Results from a Prospective Randomized Trial

Aim: to compare the effectiveness and oncological safety of colon preparation for surgical treatment in patients with colorectal cancer complicated with obstructive colonic ileus using endoscopic stenting and protective ostomy.

Materials and methods. A prospective, single-center, randomized study was carried out. All patients with colorectal cancer complicated with obstructive colonic ileus consecutively admitted to the Proctology Clinic of the University Clinical Hospital No. 2 of the Sechenov University were included in the study. Patients were randomized into two groups: Group 1 (study group) included patients who underwent endoscopic placement of a self-expanding metal stent to resolve obstructive colonic ileus; Group 2 (control group) included patients who underwent protective ostomy.

Results. Endoscopic stenting requires less general anesthesia and can be performed outside the operating room. The duration of decompression surgery is statistically significantly shorter with stenting compared to ostomy: 23 [20–30] and 50 [40–60] min, respectively (p < 0.001). The rehabilitation period, which is also the period of preparation for the main surgical intervention, with stenting was 4 [3–5] days, which was statistically significantly shorter compared to the control group (p < 0.001). Satisfactory quality of colon preparation after decompression in the study group was noted in 92.9 % of cases, in the control group — in 50 % of cases (p < 0.001). The result of nutritional correction in both groups was assessed as positive, however, in intergroup comparison, the level of serum albumin was statistically significantly higher in the group of stented patients (p = 0.015). The duration of the main surgery was statistically significantly longer in the ostomy group than in the study group: 300 [270–320] vs. 180 [160–220] min, respectively (p < 0.001). The results of the data indicating the oncological safety of both decompression methods were similar.

Conclusion. Endoscopic stenting of tumor stenosis in obstructive colonic ileus may be considered a preferable option for preoperative colon decompression compared to unloading stoma in the treatment of complicated forms of colorectal cancer within a single hospitalization.

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