Role and timing of colonic stenting in colorectal cancer

We are grateful for the opportunity to review the role of stenting in colorectal cancer. This technique is an important tool in the armamentarium of the clinician treating colorectal cancer and emergency presentations of malignant large bowel obstruction. Large bowel obstruction due to colorectal cancer is a common condition, traditionally treated by open surgery and creation of a colostomy (Hartmann procedure). There are now numerous options for treating this condition of which stenting is but one. We will discuss in this review how to assess patients for potential stenting. We will review stenting both as a means to palliate large bowel obstruction but also consider whether there is a role for using this as ‘bridging treatment’ to more definite surgical intervention and when this may be appropriate. Indications for the procedure, as well as a guide to correct technique for safe and effective insertion are presented. Details around the design principles and commercially available products are reviewed. Timing of such procedures, their safety profile and potential associated pitfalls are all discussed. Some controversies around the use of stenting are also described. Finally, a series of cases illustrating the utility of colonic stenting are presented to provide clinical context to the topic.