Emergency surgery for malignant large bowel obstruction: Assessing management options and outcomes

Table 1 Summary of favorable features and complications of self-expanding metal stents used as a bridge to surgery

Favorable features	Complications/unfavorable features
Timely relief of bowel obstruction	Perforation
Allows colonoscopy/imaging to rule out the possibility of synchronous tumors	Stent migration
Enables preoperative cancer staging	Chronic pain or tenesmus
Optimization before surgery: (1) Fluid and electrolyte correction; (2) Nutritional support; and (3) Bowel cleansing/preparation	Stent obstruction due to: (1) Tumor ingrowth; (2) Tumor overgrowth; and (3) Stool impaction
Relatively higher rates of primary anastomosis	Ulceration/bleeding
Reduced risk of permanent stoma	Infection at the stent site
Lower morbidity rates compared to emergency surgery; postoperative mortality rates comparable	Theoretical risk of tumor dissemination owing to tissue pressure exacerbation by stent-related shearing force

Table 2 Contraindications and technical challenges associated with self-expanding metal stent insertion

Absolute contraindications or major concerns	Relative contraindications and/or technical challenges
Perforation	Extracolonic obstruction
Colonic ischemia	Peritoneal metastases
Intra-abdominal abscess	Peritoneal fibrous adhesions
Peritonitis	Tumors located within 5 cm of the anal verge