Obstructing left colonic carcinomas

In France, up to 70 % of acute colonic obstructions are due to malignancyand nearly 16 % of patients with colorectal cancers presentwith obstructive symptoms. Two out of three obstructing coloniccarcinomas are located between the splenic flexure and the colorectaljunction. Primary diverting colostomy through an elective incisionfollowed by oncologic colonic resection 8 to 15 days later isrecommended by the French Consensus Conference about coloniccancer and by the American Association of Colorectal Surgeons.Primary colonic resection without anastomosis (Hartmann procedure),subtotal colectomy with ileorectal anastomosis or primarysegmental colectomy with intraoperative antegrade colonic lavageare technically more demanding in emergency conditions. Selfexpandingcolorectal metallic stents introduced through the tumorunder radiologic or endoscopic control might offer an alternative tosurgical intervention. Complications related to stenting are colonicperforation (4%), or haemorrhage. Technical success is achieved in92% and clinical success in 88%. When used successfully as "abridge to surgery", stents allow a secondary single-stage electivecolonic resection some days later. Colorectal stents are still waitingfor a clinical validation when compared to primary surgery and,starting in January 2003, a randomized comparison between thesetwo approaches is running in France. If metastatic disease is discoveredor surgical risks are high, stenting can be used for palliation.In palliative situations, secondary complications are stent migration(10%) or obstruction (10%).