ABSTRACT

Obstruction is not rare in patients with a left colon or upper rectal cancer. In this case, the application of self-expandable metallic stens (SEMS) can resolve symptoms in 80 to 95% of the patients. Retrospective studies have revealed that SEMS can be used for palliation in severely ill patients and for those who are not candidates for curative resections, and this technique has been shown to decrease morbidity, the possibility of a stoma and length of stay, but there is a certain risk of perforation during application or later when the patient is under chemotherapy. Similar advantages have been shown in case match and non randomized studies, when SEMS are used as bridge-to-surgery. However, prospective randomized trials revealed controversial results. In addition, considering the fact that the largest prospective randomized trial was prematurely terminated because of high perforation rates and the possibilities of silent perforations up to 20% of all cases, it may be logical to be cautious in SEMS use aiming bridge-to-surgery in these cases, who are potentially candidates for curative resections.