Both studies concluded that there is no convincing evidence that mechanical bowel preparation is associated with reduced rates of anastomotic leakage after elective colorectal surgery. Finally in 2009 Kam et al published a systematic review on ICI vs. MD in left-sided colorectal emergencies: they included 1

RCT, 1 prospective comparative trial and 5 prospective descriptive case series and concluded that, although the power of studies is poor and large-scale prospective randomized trial is desirable, no statistical significance could be shown between the two procedures [34]. Recommendation:during segmental resection and primary anastomosis for OLCC (without cecal perforation or evidence of synchronous right colonic cancers), either MD or ICI can be performed as the two techniques find more are associated with same mortality/morbidity rate. The only significant difference is that MD is a shorter and simpler procedure. Either procedure could be performed, depending of the experience/preference of the surgeon (Grade of recommendation 1A). Endoscopic Colonic Stents (SEMS) Colonic stents were introduced in the 1990 s and have been used for palliation or as a bridge to surgery:

following release of the obstruction with an endoscopic stent the patient is properly staged and offered multidisciplinary treatment and eventually elective or semi-elective surgery [35]. A) Palliation: endoscopic colonic stents (SEMS) vs. colostomy (C) There are three RCTs comparing colostomy vs. SEMS for palliation of selleck chemical malignant GW-572016 price colonic obstruction [36–38]. Xinopulos et al in 2004 randomized 30 patients. In the SEMS group placement of the stent was achieved in 93.3% (14/15 pt); there was no mortality. In 57% (8/14) of patients in which the stent was successfully placed, colonic obstruction was permanently released (i.e. until death). Mean survival was 21,4 month in SEMS group and 20,9 months in C group. Mean hospital stay was quite high in both groups and significantly higher in group C: 28 days vs. 60 days. This study presented several limitations, and the small sample size might have limited the

ability to discern differences between groups [36] Fiori et al in 2004 randomized 22 patients to either C or SEMS: mortality was 0% in both groups, morbidity was similar. SEMS group had oxyclozanide shorter time to oral intake, restoration of bowel function, and hospital stay. This study was also limited by the small simple size and by the lack of follow up [37] The Dutch Stent-in I multicenter RCT was planned to randomized patients with incurable colorectal cancer to SEMS or surgery: the study was terminated prematurely after enrolling 21 patients because four stent-related delayed perforations resulting in three deaths among 10 patients in the SEMS group. There are no clear explanation for such a high perforation rate; the authors pointed out that limited safety data existed fort he stent used in their study (WallFlex, Boston Scientific Natick, MA) [38].