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Controversial issues of colon stenting in case of tumor obstructive intestinal obstruction: surgical and oncological aspects
Journal: Endoscopic Surgery. 2025;31(2): 65‑75
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To cite this article:
Aliyev SA, Aliyev ES, Aliyev TK. Controversial issues of colon stenting in case of tumor obstructive intestinal obstruction: surgical and oncological aspects. Endoscopic Surgery.
2025;31(2):65‑75. (In Russ.)
https://doi.org/10.17116/endoskop20253102165
The literature data on the treatment of colon cancer complicated by obstructive intestinal obstruction using minimally invasive endoscopic (stent) surgical technology are analyzed. Based on data from systematic reviews and meta-analyses of randomized controlled trials, the effectiveness of colon stenting has been substantiated, which makes it possible to exclude intermediate stages of multi-stage surgical treatment in potentially operable patients with initially resectable colorectal cancer. Pre-decompression of the colon by installing a stent ensures complete unloading, allows postponing emergency surgery and performing it after additional therapeutic and diagnostic measures in safer conditions with the least risk. The possibilities and prospects of colon stenting are described, taking into account the surgical and oncological aspects of obstructive intestinal obstruction. The advantages and disadvantages of the methodology are outlined in a discussion style. It has been shown that the use of two-stage surgical treatment tactics with preliminary colon stenting at the first stage and performing radical operations to restore colon continuity at the second stage in potentially operable patients with initially resectable colorectal cancer can improve immediate and long-term results, as well as improve the quality of life of patients. In the late stages of the malignant process and the presence of unresectable colorectal cancer, colon stenting can serve as the preferred and final palliative treatment in a severe category of inoperable patients. A statistically significant decrease in the frequency of postoperative complications, ranging from 3.6% to 10.5%, a low mortality rate, ranging from 2.7% to 13.6%, an expansion in the possibility of performing primary radical and simultaneous reconstructive operations from 55% to 69.8%, as well as a significant reduction in the total duration of hospitalization and postoperative rehabilitation. demonstrate the undeniable advantages of colon stenting. In the context of the oncological aspects of the problem, it has been proven that colon stenting, as a worthy alternative to traditional surgery, is acceptable as a temporary measure and palliative treatment for inoperable patients, with the exception of patients receiving chemotherapy based on monoclonal antibodies that inhibit angiogenesis, due to the high risk of stent-induced perforation of the colon. The ambiguous long-term oncological results of CTK, the absence of a certain discriminatory level of indicators of general, relapse-free and tumor-specific survival of patients compared with those using traditional surgical tactics require a strict and differentiated approach to this technique, taking into account the localization, stage of ROC and the extent of tumor stenosis.
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Received:
17.04.2024
Accepted:
31.07.2024
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