Palliative stent implantation in the treatment of malignant colorectal obstruction

Ptok, H.; Meyer, Frank; Marusch, F.; Steinert, R; Gastinger, I.; Lippert, H.; Meyer, L.

doi:10.1007/s00464-005-0594-7

Cited by 64 publications

(51 citation statements)

References 30 publications

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“…The authors concluded that the high perforation rate could be either specifically WallFlex-related or enteral-stent-related in patients on chemotherapy. In contrast, one study conducted in the same year as the previously cited randomised trial and using the WallFlex stent was associated with a perforation rate below 5% (19), which is in line with previous studies using other stents (11,14,20). The results of prospective trials and of recent retrospective studies further demonstrated the effectiveness of SEMS in the palliative management of malignant colorectal obstruction (6,7,(12)(13)(14)21).…”

Section: Discussionsupporting

confidence: 82%

“…These results, however, conflict with other studies reporting short-and longterm clinical failure in more than 50% of patients, along with a high number of severe complications (4,5). Furthermore, several risk factors have been associated with stent patency, complications and clinical outcomes, as well as with conflicting results (1,6,(12)(13)(14). The question remains: are SEMS used for definitive palliation of malignant colorectal obstruction as successful as those used as a bridge to surgery?…”

Section: Introductionmentioning

confidence: 92%

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Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Liberato

Marques

et al. 2012

Rev. esp. enferm. dig.

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Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data.Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients' lives and related factors affecting stent patency, clinical success and complications.Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients' lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications.Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06).Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.Key words: Self-expanding metal stent. Colorectal obstruction. Endoscopic definitive palliation. INTRODUCTIONColorectal cancer is one of the most common malignancies worldwide (1). In patients with colorectal cancer, obstruction occurs in 15 to 20% (2). Most of these patients have advanced disease and are often elderly, with significant comorbidities (2-4). In this group of patients, curative resection is not frequently feasible (4,5). Therefore, palliation is the primary aim in these patients (3,6,7). Emergency surgical decompression is associated with high mortality and morbidity figures (8,9). In addition, surgery often involves creation of a...

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 92%

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Liberato

Marques

et al. 2012

Rev. esp. enferm. dig.

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“…Она развивается у 26,4-69,0% па-циентов [10][11][12]. Наиболее характерно это ослож-нение для опухолей левых отделов толстой кишки (67-72%), что связано с особенностями местного роста рака этой локализации (эндофитный, цир-кулярный), спецификой интрамурального лимфо-оттока, а также большей плотностью опухоли этой локализации и меньшим диаметром кишки [13][14][15][16][17].…”

Section: актуальность проблемыunclassified

Complications in the treatment of colorectal cancer

Денисенко¹,

Gain²

2015

Endosk. khir.

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“…In palliative settings, SEMS also significantly reduce the chance of stoma creation, length of hospital stay, mortality rate, and medical complications compared with palliative surgery [1, [13][14][15]. Additionally, it allows these patients to enjoy the full benefits of minimally invasive surgery [16].…”

mentioning

confidence: 99%

“…It is a common cause of delayed recurrent obstruction following apparently successful initial SEMS implantation, especially with the use of uncovered stents [10,21]. Prospective studies and systemic reviews showed that the time for colonic reobstruction ranged from 48 hours to 480 days after stent placement [6,13,14,21]. This variation in stent patency duration may be due to difference in demographic factors, underlying malignancies, or types of stents used [6,14].…”

mentioning

confidence: 99%

Management of Recurrent Large Bowel Obstruction Due to Stent Occlusion by ‘Stent-Over-Stent’: A Case Report and Literature Review

Tsang¹,

Cheung²,

Chung³

et al. 2011

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Endoscopic stenting for malignant large bowel obstruction is common nowadays. However, recurrent obstruction secondary to stent occlusion due to tumour ingrowth or overgrowth might occur. We reported a case of a 70-year-old man with large bowel obstruction initially treated with colonic stenting. It was complicated with recurrent intestinal obstruction, with colonoscopy showing stent blockage by tumour ingrowth over distal part of the stent. Successful endoscopic implantation of additional colonic stent over the old stent was achieved and intestinal obstruction was resolved afterwards.

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Palliative stent implantation in the treatment of malignant colorectal obstruction

Abstract: For palliative treatment of malignancy-induced colorectal obstruction, SEMS is an efficient tool associated with low morbidity and minimal mortality. From a technical point of view, all tumor locations are accessible.

Cited by 64 publications

References 30 publications

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Complications in the treatment of colorectal cancer

Management of Recurrent Large Bowel Obstruction Due to Stent Occlusion by ‘Stent-Over-Stent’: A Case Report and Literature Review

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