Clinical outcomes of palliative self‐expanding metallic stents in patients with malignant colorectal obstruction

Abstract

OBJECTIVE:Self-expanding metallic stents (SEMS) are useful palliative option and a bridge to surgery in malignant colorectal obstruction. The aim of this study was to evaluate the clinical outcomes of SEMS to palliate colorectal malignant obstruction. METHODS:Malignant colorectal obstructive patients who underwent SEMS insertion at the National Cancer Center, Korea from January 2004 to June 2008 were enrolled in the study. Patients' clinical characteristics, outcomes and complications for palliative SEMS insertion were retrospectively analyzed. RESULTS:A total of 54 patients were enrolled in the palliative SEMS group and 48 patients with obstructive CRC were included in the SEMS as the bridge to surgery group. Obstruction of the left colon occurred in 52 patients of the palliative SEMS group and all patients in SEMS as bridge to surgery group. For primary SEMS insertion, the technical success (TS) rate was 87.0% and the clinical success (CS) rate 89.4%, while the rates of early and late complications were 24.1% and 23.4%, respectively. There was no procedure-related mortality. Stent migration rate was higher in the cases treated with small diameter and covered type of stents. Median time to reobstruction and migration were 85 and 101 days, respectively. TS and CS rates for SEMS reinsertion were comparable to those for primary SEMS insertion. CONCLUSIONS:Palliative SEMS are effective and favorable procedures for malignant colorectal obstruction but with some complications. Stent migration is associated with covered type and small diameter stents while other factors including length of stent and chemotherapy do not affect stent complications in the present study.

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

“…The median time to reintervention in this study was 4·6 (i.q.r. 2·3–7·7) months, similar to previous reports16 18. This duration of patency should be taken into account when selecting the appropriate management in patients with stage IV colorectal cancer who present with large bowel obstruction.…”

“…Some 1–17 per cent of patients with a stent develop recurrent obstruction due to tumour ingrowth5 17, 18, 19. The options for further treatment at this stage are either surgery or reinsertion of a second stent within the first.…”

Place des prothèses coliques dans la stratégie thérapeutique du cancer colorectal

“…Les complications à 30 jours concernent 16 à 31 % des patients [31][32][33]. Le pourcentage de perforations différées par rapport à la pose de la prothèse varie de 1 à 7 % (taux moyen : 3,9 %).…”

“…Le pourcentage de perforations différées par rapport à la pose de la prothèse varie de 1 à 7 % (taux moyen : 3,9 %). Le risque de perforations différées semble associé au type de prothèse utilisée, à la présence préala-ble d'une carcinose péritonéale et à l'administration d'une chimiothérapie comprenant un traitement antiangiogénique [32,33]. Il faut donc tenir compte de ce risque de perforation accru chez des patients pour lesquels la chimiothérapie serait indiquée après la pose d'une prothèse.…”

Kolonstents als «Bridge to Surgery»

“…Fallserien und größere monozentrische Studien [7,8,9,10] mit unterschiedlichen Patientenzahlen (vor allem auch zunehmend aus Fernost) berichten über hervorragende Ergebnisse für die kolorektale Stentimplantation mit hoher Effektivität (technischer/klinischer Erfolg: 87–95/89%) und niedrigen Komplikationsraten (11–47%).…”