Role of self expandable stents in management of colorectal cancers

Acute malignant colorectal obstruction is a complication of colorectal cancer that can occur in 7%-29% of patients. Self-expanding metallic stent placement for malignant colorectal obstruction has gained popularity as a safe and effective procedure for relieving obstruction. This technique can be used in the palliation of malignant colorectal obstruction, as a bridge to elective surgery for resectable colorectal cancers, palliation of extracolonic malignant obstruction, and for nonmalignant etiologies such as anastomotic strictures, Crohn's disease, radiation therapy, and diverticular diseases. Self-expanding metallic stent has its own advantages and disadvantages over the surgery in these indications. During the insertion of the self-expanding metallic stent, and in the followup, short term and long term morbidities should be kept in mind. The most important complications of the stents are perforation, stent obstruction, stent migration, and bleeding. Additionally, given the high risk of perforation, if a patient is treated or being considered fortreatmentwith antiangiogenic agents such as bevacizumab, it is not recommended to use self-expanding metallic stent as a palliative treatment for obstruction. Therefore, there is a need for careful clinical evaluation for each patient who is a candidate for this procedure. The purpose of this review was to evaluate self-expanding metallic stent in the management of the obstruction of the colon due to the colorectal and extracolonic obstruction.

Minimally invasive techniques in benign and malignant adrenal tumors

Minimally invasive adrenalectomy has become the main treatment modality for most adrenal lesions.Both laparoscopic transabdominal and retroperitoneoscopic approaches are safe and feasible options,each with respective advantages,including better surgical outcomes,fewer complications,and faster recovery over open adrenalectomy.While open surgery remains a valid modality in treatment of adrenocortical cancer in the presence of some findings such as invasion,robotic platforms,and minimally invasive surgery have gained popularity as technology continues to evolve.Organ preservation during adrenalectomy is feasible in some conditions to prevent adrenal insufficiency.Ablative technologies are increasingly utilized in benign and malignant tumors,including the adrenal gland,with various outcomes.A multidisciplinary team,an experienced surgeon,and a highvolume center are recommended for any surgical approaches and management of adrenal lesions.This review article evaluated recent findings and current evidence on minimally invasive adrenalectomy.