Outcome of endoscopic self-expandable metal stents in acute malignant colorectal obstruction at a tertiary center

Abstract

Background: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS) may be used in acute MCRO.Aim: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance.Methods: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period.Results: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19) and palliation in the remaining 60% (n = 28). The location of the tumor did not influence the presence of lymph node involvement (p = 0.764) nor metastasis (p = 0.885). Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001). Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385), early (p = 0.950) or late complications (p = 0.057). Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%.Conclusions: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance.

The long-term recurrence rate and survival of obstructive left-sided colon cancer patients: a stent as a bridge to surgery

“…Emergency surgery has been the treatment of choice for many years with an associated high morbi-mortality, and a stoma needs to be performed in up to 40% of cases (2)(3)(4). In more than 50% of these patients, intestinal transit is not subsequently repaired (5). The use of the colonic stents as a bridge to elective surgery versus emergency surgery was compared in a systematic review of seven randomized studies (6).…”

Self-Expandable Metal Stent as a Bridge to Surgery for Obstructing Colonic Cancer: Still a Hot Topic for Debate

“…Over the last decades many retrospective studies, randomized controlled trials (RCTs) and also systematic reviews have been published on the subject of colonic stenting for MLBO. 4 , 5 , 6 , 7 , 8 , 9 However, the management of this severe clinical condition remains controversial.…”