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

Abstract

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...

Predictors of Complications and Mortality in Patients with Self-Expanding Metallic Stents for the Palliation of Malignant Colonic Obstruction

“…On the other hand, others demonstrate shorter hospital stay, comparable risk of short-term complications and mortality, and cost-effectiveness [8,12] . Sustained relief of obstructive symptoms without re-intervention is an important outcome, and several studies show that long-term clinical efficacy of SEMS can be maintained until death in the great majority of patients [19][20][21] .…”

Palliative Stenting for Malignant Large Bowel Obstruction: Stents for All?

“…This is also true with respect to the application of a self-expandable metallic stent (SEMS) as a definitive palliative treatment in obstructive colorectal cancer. In the last years of the first decade of the 21 st century, papers concerning SEMS, as a nonsurgical palliative treatment for malignant colorectal obstruction, always asked the same question in the introduction: "the question remains: are SEMS used for definitive palliation of malignant colorectal obstruction as successful as those Colorectal cancer is one of the leading malignancies worldwide [4,9] . One of the most common complications is obstruction, which can occur in up to 20% of the patients [4,7] .…”

“…In the last years of the first decade of the 21 st century, papers concerning SEMS, as a nonsurgical palliative treatment for malignant colorectal obstruction, always asked the same question in the introduction: "the question remains: are SEMS used for definitive palliation of malignant colorectal obstruction as successful as those Colorectal cancer is one of the leading malignancies worldwide [4,9] . One of the most common complications is obstruction, which can occur in up to 20% of the patients [4,7] . The majority of patients presenting with obstruction have advanced disease, are often elderly individuals, and have overall a poor medical condition [4,7,10,11] .…”

“…One of the most common complications is obstruction, which can occur in up to 20% of the patients [4,7] . The majority of patients presenting with obstruction have advanced disease, are often elderly individuals, and have overall a poor medical condition [4,7,10,11] . Curative treatment is not feasible, and therefore palliation is the primary aim in these patients [1,4,10,12] .…”

“…The majority of patients presenting with obstruction have advanced disease, are often elderly individuals, and have overall a poor medical condition [4,7,10,11] . Curative treatment is not feasible, and therefore palliation is the primary aim in these patients [1,4,10,12] . Emergency surgery in patients with an unprepared colon leads to significant morbidity and mortality [4,13,14] .…”