Palliative self-expandable metal stents for acute malignant colorectal obstruction: clinical outcomes and risk factors for complications

Han, Jae Pil; Hong, Su Jin; Kim, Shin Hee; Choi, Jong Hyo; Jung, Hyun-Joo; Cho, Youn Hee; Ko, Bong Min; Lee, Moon Sung

doi:10.3109/00365521.2014.920914

Cited by 7 publications

(11 citation statements)

References 33 publications

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“…Although studies investigating the efficacy of systemic chemotherapy in patients with SEMS are limited to small sample sizes, several studies have demonstrated significantly better survival with systemic chemotherapy in patients with SEMS compared with best supportive care (BSC) [40,41]. However, systemic chemotherapy may increase the risk of SEMS-related complications, such as migration resulting from tumor response, re-obstruction due to in-and outgrowth of the tumor, and perforation, which could be potentially critical [42][43][44]. Findings in published reports (including patients with and without chemotherapy) have shown procedure-and SEMS-related complications in 5%-23% of patients, with an average rate of SEMS-related perforation in 5% of patients [12,[45][46][47].…”

Section: Previous Reports Of Systemic Chemotherapy In Patients With Semsmentioning

confidence: 99%

Systemic Chemotherapy is a Promising Treatment Option for Patients with Colonic Stents: A Review

Matsuda

Yamada

Matsumoto

et al. 2021

J Anus Rectum Colon

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Approximately 10% of patients with colorectal cancer (CRC) develop malignant large bowel obstruction (MLBO) at diagnosis. Furthermore, for 35% of patients with MLBO, curative primary tumor resection is unfeasible because of locally advanced disease and comorbidities. The practice of placing a self-expandable metallic stent (SEMS) has dramatically increased as an effective palliative treatment. Recent advances in systemic chemotherapy for metastatic CRC have significantly contributed to prolonging patients' prognosis and expanding the indications. However, the safety and efficacy of systemic chemotherapy in patients with SEMS have not been established. This review outlines the current status of this relatively new therapeutic strategy and future perspectives. Some reports on this topic have demonstrated that 1) systemic chemotherapy and the addition of molecular targeted agents contribute to prolonged survival in patients with SEMS; 2) delayed SEMS-related complications are a major concern, and this requires strict patient monitoring; however, primary tumor control by chemotherapy might result in decreased complications, especially regarding re-obstruction; and 3) using bevacizumab could be a risk factor for SEMS-related perforation, which may be lethal. Although this relatively new approach for unresectable stage IV obstructive CRC requires a well-planned clinical trial, this therapy could be promising for patients who are unideal candidates for emergency surgery and require immediate systemic chemotherapy.

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Section: Previous Reports Of Systemic Chemotherapy In Patients With Semsmentioning

confidence: 99%

Systemic Chemotherapy is a Promising Treatment Option for Patients with Colonic Stents: A Review

Matsuda

Yamada

Matsumoto

et al. 2021

J Anus Rectum Colon

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“…SEMS has a lower morbidity rate and similar efficacy compared with palliative surgery, avoiding unnecessary operations and providing a better quality of life. 16,22,23 A randomized control trial from 2015 24 with a sample of 56 patients with unresectable metastatic spread tried to evaluate the effect of the two palliative procedures on patients well being and symptoms relief. The quality of life scores were superior in the group of patients with SEMS comparing with the group submitted to surgical decompression, particularly in the first weeks.…”

Section: Sems (Self-expanding Metal Stent)mentioning

confidence: 99%

Endoscopic stent in malignant colonic obstruction: the risk of tumor seeding

Leite

Barbosa

2019

Journal of Coloproctology

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Introduction Malignant colonic occlusion is traditionally considered a surgical emergency. With the development of endoscopic techniques, metallic stents have emerged to ensure the colonic patency in nonsurgical candidates and, more recently, as a temporary measure until elective resection surgery is possible. Materials and methods The research was conducted in PubMed and collected a total of 46 articles, including cross-references. Results Ideally, intestinal occlusion should be resolved through tumor's primary resection with direct anastomosis. To avoid dehiscence of the anastomosis, tumor's resection may be performed with Hartmann's procedure. Metal stents are an alternative to emergency surgery and show excellent results in reliving colonic obstruction. However, they may have serious complications related to colonic perforation, migration and tumor dissemination. Discussion and conclusion Observational studies and clinical trials show discrepant results. Metal stents are increasingly accepted in palliative care but are not yet recommended as a bridge to curative surgery. Treatment should be individualized, according to surgical risk and the probability of endoscopic complications.

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“…Literature searching gave rise to 207 studies, of which 10 were eligible [5,[8][9][10][11][12][13][14][15][16]. These included seven prospective cohort studies, two retrospective cohort studies and one RCT, in total 753 patients.…”

Section: Results Of Searchmentioning

confidence: 99%

“…The summary and results of methodological quality assessment of the one RCT [8] and nine observational studies [5,[9][10][11][12][13][14][15][16] are demonstrated graphically in Fig. 2.…”

Section: Methodological Qualitymentioning

confidence: 99%

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Uncovered versus covered stent in management of large bowel obstruction due to colorectal malignancy: a systematic review and meta-analysis

Mashar

Hajibandeh

2019

Int J Colorectal Dis

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Purpose To compare outcomes of uncovered stent and covered stent in management of large bowel obstruction secondary to colorectal malignancy. Methods We conducted a search of electronic databases identifying studies comparing outcomes of uncovered and covered stents in management of large bowel obstruction secondary to colorectal malignancy. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess the included studies. Random or fixed effects modelling were applied as appropriate to calculate pooled outcome data. Results One randomised controlled trial (RCT) and nine observational studies, enrolling 753 patients, were identified. Uncovered stent was associated with lower risks of complications (RR 0.57 95% CI 0.44-0.74, P < 0.0001), tumour overgrowth (RR 0.29 95% CI 0.09-0.93, P = 0.04), and stent migration (RR 0.29 95% CI 0.17-0.48, P < 0.00001); longer duration of patency (MD 18.47 95% CI 10.46-26.48, P < 0.00001); lower need for stent reinsertion (RR 0.38 95% CI 0.17-0.86, P = 0.02); and higher risk of tumour ingrowth (RR 4.53 95% CI 1.92-10.69, P = 0.0008). Rates of technical success (RR 1.02 95% CI 0.99-1.04, P = 0.21), clinical success (RR 1.03 95% CI 0.98-1.08, P = 0.32), perforation (RD 0.01 95% CI − 0.03-0.02, P = 0.65), bleeding (RD 0.00 95% CI − 0.03-0.03, P = 0.98), stool impaction (RR 0.56 95% CI 0.12-2.04, P = 0.38) and stent obstruction (RR 2.23 95% CI 0.94-5.34, P = 0.97) were similar. Conclusions Our results suggest that uncovered stents are superior as indicated by fewer complications, lower rates of stent migration, longer duration of patency and a reduced need for stent reinsertion. The best available evidence is mainly derived from non-randomised studies; there is a need for more RCTs.

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Palliative self-expandable metal stents for acute malignant colorectal obstruction: clinical outcomes and risk factors for complications

Abstract: The administration of CT increases the rate of stent migration, and disease control by CT can reduce the risk of obstruction by maintaining the luminal patency of palliative SEMSs.

Cited by 7 publications

References 33 publications

Systemic Chemotherapy is a Promising Treatment Option for Patients with Colonic Stents: A Review

Systemic Chemotherapy is a Promising Treatment Option for Patients with Colonic Stents: A Review

Endoscopic stent in malignant colonic obstruction: the risk of tumor seeding

Uncovered versus covered stent in management of large bowel obstruction due to colorectal malignancy: a systematic review and meta-analysis

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