Endoprótesis como tratamiento del cáncer colorrectal obstructivoanálisis de morbimortalidad y pronóstico oncológico

Abstract

In 20 to 30 per cent of cases, colon cancer initially presents with acute large bowel obstruction. When the obstruction site is located in the right and transverse colon, the usual treatment consists in urgent surgical resection with primary anastomosis, but in patients with left-colon obstruction the situation becomes more complex, as emergency surgery involves great morbidity and mortality. The research to find a therapeutic alternative to surgery came to an end in the early 90's, when Dohmoto et al. developed a self-expanding stent that could be introduced endoscopically and open the colon stenotic area. Thus, this device could be used for palliative care or as a bridge to surgery therapy. Its use rapidly spread around the world, as a high efficiency (80-90%) and a low morbidity and mortality rate was reported in the first clinical studies. However, in the following reviews, a higher complication rate was found. In fact, several clinical trials were interrupted between 2000 and 2010 due to the stent-related morbidity and mortality. Additionally, more doubts raised among professionals as a worst oncologic outcome of stenting cases was referred in some series. Although the more recent meta-analysis show no difference in survival terms between both procedures (120,127), this issue remains under debate among many specialists...