Colonic stenting in the management of malignant intestinal obstruction in elderly patients

Abstract

Acute intestinal obstruction occurs in 7-30% of patients with colorectal carcinoma, especially if tumour is located at or distal to the splenic flexure. Traditionally, emergency surgical decompression is the treatment option, with the resection of obstructing tumour and often with the creation of defunctioning stoma. Emergency surgical decompression is very effective, but it is associated to high mortality rate, depending on patients comorbidities, anaesthetic and emergency surgery risks. Moreover stoma causes high morbidity rate and a worsening in quality of life, with up to 60% patients that would never be reversed [1]. An alternative to surgery is intraluminal colorectal stenting, first described by Dohmoto in 1991 in 19 patients with non-resectable metastatic rectal cancer. In 1993 Tejero used metallic stents in patients with colon obstruction as “bridge to surgery” [2]. Since its introduction self-expandable metal stent (SEMS) has increasingly been used for malignant colon obstruction and several studies showed its efficacy in relieving the obstruction offering good palliation, and, whenever possible, avoiding emergency surgery and facilitating single-stage surgery, reducing stoma creation. Colonic stenting is also associated to complications, as intestinal perforation, stent migration and clinical failure. Nowadays there is debate concerning five-years survival and cancer-specific mortality: it seems that five-years survival is lower and cancer-specific mortality is higher in SEMS patients compared to urgent surgery patients, because of delayed surgery [3]. The aim of the study was to review our experience and assess the effectiveness of colonic stenting in malignant colon obstruction, as a “bridge to surgery” or as a palliative treatment, in terms of safety, efficacy and clinical outcomes.