By Hwa A. Lim

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2. Stent deployed over guidewire (Courtesy of Farhan Ahmad). 23 COLONIC STENTING Endoscopic/Fluoroscopic Placement The distal end of the obstructing lesion is visualized endoscopically at which point a biopsy may be taken. The length and con­ figuration of the stenosis is demonstrated fluoroscopically by injection of water-soluble contrast media. The guidewire is then passed through the stenosis and the stent delivery system inserted through the scope. The stent is positioned at the level of the stenosis and released under both endoscopic and radiological vision.

With thorough preoperative planning, meticulous intraoperative technique, and wide anatomic resection, multivisceral surgeries may result in cure, which should remain our chief objective. The most important factor in preventing local recurrence is obtaining a tumor-free resection margin, as patients rarely benefit from an incomplete resection. However, as Lopez points out, multivisceral resections are not standardized procedures, and not all surgeons should attempt them. The best course for a surgeon unwilling or unable to perform extensive multivisceral resection in the setting of unexpected intraoperative findings is to seek immediate consultation with a more experienced colleague, or else to close the abdomen and refer the patient to a specialty center with significant expertise in Alektiar KM, Zelefsky MJ, Paty PB et al (2000) High-dose rate intraoperative brachytherapy for recurrent colorectal cancer.

BMJ 327:1196–1201 Tekkis PP, Kinsman R, Thompson MR et al (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81 Turegano-Fuentes F, Echenagusia-Belda A, Simo-Muerza G, Camunez F, Munoz-Jimenez F, Del Valle Hernandez E, Quintans-Rodriguez A (1998) Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon. Br J Surg 85(2):232–235 van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA; On behalf of the Dutch Stent-In Study Group (2006) Premature closure of the Dutch Stent-in I study.

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