Efficacy of transanal drainage tube and self-expanding metallic stent in acute left malignant colorectal obstruction.

Background: The self-expanding metal stent (SEMS) or transanal drainage tube (TDT) methods can be used as a palliative treatment before tumor resection surgery. Studies systematically comparing the efficacy and characteristics between SEMS with TDT are limited, especially in a large-scale Chinese population. This retrospective study aimed to compare the outcomes of these treatment approaches. Methods: This was a retrospective comparative study of patients with an acute malignant left colorectal obstruction who underwent a preoperative decompressive procedure with SEMS or TDT intervention between December 2014 and October 2017. The indicators after endoscopic treatment and tumor resection surgery between the SEMS and TDT groups were compared. Results: 206 patients underwent endoscopic intervention to relieve obstruction, including 139 patients treated with SEMS and 67 patients treated with TDT. The technical success rates of the SEMS group and TDT group were 97.1% and 95.6%, respectively, and the rates of obstruction relief were 92.8% and 86.6%, respectively. TDT was more easily translocated than SEMS (P=0.02), and there was no significant difference in the incidence of other complications. However, SEMS had a lower complication rate than TDT (P=0.02), and could alleviate the obstruction faster (P<0.01). There were 72 patients and 44 patients who took resection surgery in the SEMS group and TDT group, respectively. The direct anastomosis rates were 73.6% and 63.6% (P=0.26), respectively, and only 1 case in the TDT group had anastomotic leakage. The surgery time of the SEMS group was significantly shorter than that of the TDT group (P=0.01). There was no significant difference between the 2 groups in terms of postoperative hospital stay (P=1.00) or total treatment costs for patients undergoing surgery (P=0.26). Conclusions: Both TDT and SEMS could effectively relieve acute left malignant colorectal obstruction with safe and reliable results, and they could both reduce the stomas rate compared with traditional surgery. SEMS could alleviate obstruction faster than TDT and had fewer complications.