Effect of self-expandable metal stent on morbidity and mortality and oncological prognosis in malignant colonic obstruction: retrospective analysis of its use as curative and palliative treatment

Recuenco, Carlos Bustamante; Septiem, Javier García; Díaz, Javier Arias; Vasallo, Israel John Thuissard; Madriz, Alejandro Andonaegui de la; Carneros, Virginia Jiménez; Rodríguez, José Luis Ramos; Navalón, José María Jover; Miramón, Francisco Javier Jiménez

doi:10.1007/s00384-021-04081-8

Cited by 6 publications

(11 citation statements)

References 37 publications

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“…In the majority of cases, MBO cannot self-resolve, which can lead to severe gastrointestinal symptoms, electrolyte imbalance, nutritional disorders, and even cachexia, posing a serious threat to patients' lives [20]. Surgery is the primary treatment for cancer-related bowel obstruction [21]. However, due to the acute onset of MBO; the short preoperative preparation period, which is often accompanied by numerous underlying diseases and malnutrition; and the complexity, di culty, and prolonged duration of surgery, postoperative complications are frequent and severe, contributing to a low postoperative survival rate [22].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis

Weng,

Lai,

Wang

et al. 2024

Preprint

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Background Malignant bowel obstruction (MBO) is a common complication in advanced abdominal cancer patients, characterized by a high overall incidence and poor prognosis. Postoperative complications are particularly frequent, with a low postoperative survival rate. The preoperative nutritional status of patients, especially the prealbumin (PA) levels, is significantly correlated with postoperative issues and long-term prognosis. This study aimed to assess the predictive value of the preoperative prealbumin (PA) concentration for postoperative complications and long-term survival in patients with malignant bowel obstruction (MBO). Methods Single-factor and multifactor logistic regression analyses were performed to identify independent risk factors for severe complications and infectious complications. Moreover, univariate and multivariate stratified Cox regression analyses were employed to identify independent risk factors for overall survival (OS), and corresponding nomograms were created. Kaplan-Meier survival curves were generated for grouped data with statistically significant differences. The area under the curve (AUC) was compared to assess the testing efficacy of different nutritional indicators for severe postoperative complications. Results There was a statistically significant difference in the comparison of overall complications and infectious complications between the two groups for different Clavien-Dindo (CD) grades (p < 0.001). Specifically, the incidence of complications with CD grade ≥ 3 in the superlow PA group was higher (p<0.001), and a gradual increase in the severity of overall and postoperative infectious complications was observed with decreasing PA levels (p < 0.001). PA (p < 0.001) and intestinal stent placement (p = 0.015) were identified as independent influencing factors for early postoperative severe complications (CD grade ≥ 3), while PA was identified as an independent influencing factor for postoperative infectious complications (p < 0.001). Cox regression analysis stratified by TNM stage revealed that age, sex, surgical method, and postsurgical chemotherapy were independent predictors of OS. Compared to indicators such as the FPR and AFP, PA demonstrated the highest testing efficiency (AUC = 0.888). Conclusion Preoperative PA has significant predictive value for early postoperative complications and overall survival in patients with MBO, providing new insights into perioperative nutritional intervention and surgical approach selection for these patients.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis

Weng,

Lai,

Wang

et al. 2024

Preprint

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“…Technical and clinical success was defined as the correct placement and expansion of the stent and the resolution of occlusive symptoms, respectively. 11 Early complications were defined as those that occurred within 14 days after palliative procedures. Delayed complications were defined as those that occurred more than 14 days after palliative procedures.…”

Section: Methodsmentioning

confidence: 99%

“…Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Technical and clinical success was defined as the correct placement and expansion of the stent and the resolution of occlusive symptoms, respectively 11 . Early complications were defined as those that occurred within 14 days after palliative procedures.…”

Section: Methodsmentioning

confidence: 99%

“… 2 In recent decades, self‐expandable metal stents (SEMS) have been widely applied both for palliation of colonic decompression in inoperable patients and for preoperative decompression in surgical candidates. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 The European Society of Gastrointestinal Endoscopy recommends colonic stenting for palliation of malignant colonic obstruction. 12 On the contrary, prophylactic stenting for asymptomatic MCS is not recommended, 12 although MCS, regardless of the presence of obstructive symptoms, is associated with a higher risk of acute events that require emergency surgery.…”

Section: Introductionmentioning

confidence: 99%

“…If the stenosis is severe enough to cause colonic obstruction, an emergency surgery, such as colostomy or resection, has traditionally been considered 2 . In recent decades, self‐expandable metal stents (SEMS) have been widely applied both for palliation of colonic decompression in inoperable patients and for preoperative decompression in surgical candidates 3–11 . The European Society of Gastrointestinal Endoscopy recommends colonic stenting for palliation of malignant colonic obstruction 12 .…”

Section: Introductionmentioning

confidence: 99%

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Palliative stenting for malignant colorectal stenosis in the elderly

et al. 2022

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Objectives Self‐expandable metal stents are widely used for the treatment of malignant colorectal stenosis (MCS). In elderly individuals with MCS, self‐expandable metal stents are often used as a palliative treatment, but prophylactic stent placement is not recommended. We investigated the efficacy and safety of self‐expandable metal stents for the elderly in a palliative setting, specifically in a prophylactic setting. Methods Elderly patients with MCS who received a palliative stent (the stent group) or palliative stoma (the stoma group) were retrospectively enrolled between April 2017 and June 2022, and the prognosis and complication rates were assessed. Additionally, patients in the stent group were divided into symptomatic and asymptomatic subgroups, and prognosis, stent patency, and complication rates were evaluated. Results During the study period, 31 patients with a mean age of 85.4 years and 12 patients with a mean age of 82.0 years were enrolled in the stent and stoma groups, respectively. While overall survival and complication rates were comparable, the length of hospital stay was significantly shorter in the stent group. Of the 31 patients in the stent group, 16 asymptomatic patients received prophylactic stenting, which was not associated with increased complication rates. Conclusions Palliative stents for MCS appear to be effective and safe even in the elderly, and thus, prophylactic stents can be considered for asymptomatic patients.

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Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol

et al. 2023

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Effect of self-expandable metal stent on morbidity and mortality and oncological prognosis in malignant colonic obstruction: retrospective analysis of its use as curative and palliative treatment

Cited by 6 publications

References 37 publications

Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis

Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis

Palliative stenting for malignant colorectal stenosis in the elderly

Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol

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