Can we use colon stenting in accelerated recovery programs for surgical treatment colon cancer complicated by obstructive intestinal obstruction? A literature review

Extensive literature data demonstrate the safety and effectiveness of colon stenting in surgical treatment of tumor colonic obstruction, as well as potential prospects and successful implementation of the Accelerated Recovery Program in the elective colorectal surgery. Based on this, the authors of this review attempted to substantiate the possibility and feasibility of including the stenting technique in the Accelerated Recovery Program as a component of its implementation in the surgical treatment of colon cancer complicated by intestinal obstruction. Due to the reduction of intermediate stages of traditional multi-step surgical treatment and the absence of colostomy and the associated need for further reintervention to eliminate the colostomy and restore colon continuity, stenting contributes to a significant reduction in the overall period of hospitalization and rehabilitation of patients, as well as a decrease in the financial and economic costs of treatment. The disadvantages, advantages, and complications of colon stenting in patients with colon cancer complicated by obstructive intestinal obstruction are described, taking into account surgical and oncological results according to the literature. It was shown that a two-step surgical treatment strategy (with preliminary colon stenting at the first stage and performing one-step radical interventions with primary restoration of colon continuity at the second step) enables to achieve better immediate and remote results and improve the quality of life of patients. At late stages of the tumor process and the presence of unresectable cancer, colon stenting can serve as a definitive palliative treatment method in inoperable patients. Within the context of oncological aspects of the problem, it is declared that colon stenting carries a risk of severe complications associated with tumor trauma, contributing to the generalization of the malignant process due to an increase in the level of carcinoembryonic antigen and an increase in the number of circulating tumor cells in the peripheral blood, significantly reducing cancer survival in potentially operable patients with a resectable cancer. It is shown that further prospective randomized studies and multivariate analysis of the results are needed to determine the location of colon stenting within the framework of the implementation of the Accelerated Recovery Program in the surgical treatment of colon cancer complicated by obstructive intestinal obstruction.