Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies

Abstract

Our experience does not support the routine use of colonic stenting for extracolonic cancer obstructing the colon. A more realistic approach is necessary including either the acceptance that the obstruction represents a life-ending event or proceeding immediately to a colostomy. Decisions should be individualised and stenting used after recognising its shortcomings.

Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery

“…Compared with our previous result of an early success rate of 95.8% in patients with incurable CRC, 21 this study demonstrated a low clinical efficacy of SEMS in patients with ECM. Although the primary sites of ECM differed between the studies, 3,4 it is evident that the clinical efficacy of SEMS placement in patients with ECM was not as high as in those with CRC. The differences in clinical efficacy of SEMS placement between primary CRC and ECM may be attributable to the different characteristics of the tumors.…”

“…Although meta-analyses demonstrated that technical and clinical success of SEMS as a palliative aim was 92% to 94% and 88% to 91%, respectively, in patients with CRC, 6,18,19 previous studies showed technical success rate of 42% to 66.7% and clinical success rates of 20% to 25% in patients with ECM. 3,4 One study argued that there was a 77% rate of clinical success in 35 patients with recurrent gynecologic cancer. 20 However, because 14 patients required subsequent surgery for continuous obstruction symptoms, the actual clinical success rate was 57%.…”

“…Other studies of patients with ECM also showed that the clinical success rate of SEMSs was significantly lower than the technical success rate 3,4. This may be attributed to the fact that patients with ECM frequently had multiple obstructive lesions.…”

“…Several retrospective studies have reported that endoscopic stenting was not effective for palliation of malignant colorectal obstruction caused by ECM. 3,4 However, previous studies had small sample sizes, and there were no reports that compared the efficacy of endoscopic stenting with that of emergency surgery.…”

Stenting for malignant colorectal obstruction: a single-center experience with 101 patients

“…Although their effectiveness in the management of malignant colorectal obstruction secondary to colorectal cancer is documented, only a few studies have examined the efficacy of palliative stenting for extracolonic malignancies [13][14][15][16][17]. Few studies have compared the effectiveness of palliative SEMS placement for colorectal obstruction between colorectal cancer and extracolonic malignancies either [18,19].…”