Mo1704 USEFULLNESS OF COLONIC STENTING FOR PALLIATIVE TREATMENT OF MALIGNANT COLONIC OBSTRUCTION

Abstract

Colorectal cancer is the most common form of cancer in Japan, and it is the second most common cause of cancer deaths worldwide. Awareness of colonic stents in the treatment of malignant colonic obstruction (MCO) has increased in Japan, and there have been many studies of their short-term usefulness as a bridge to surgery. On the other hand, the place of colonic stents as palliative treatment also deserves attention in our super-aged society. We conducted a retrospective study of MCO cases in which stenting was performed for palliative purposes in our hospital. The subjects were the 20 patients who underwent stenting as palliative treatment among the 76 patients who underwent colonic stenting for MOC in our hospital during the period from February 2013 to October 2019. We defined the technical success of stenting as the placement of a stent that passed beyond the obstruction, and we defined its clinical success as improvement in the abdominal symptoms. We used the Colorectal Obstruction Scoring System (CROSS) advocated by the Colonic Stent Safe Procedure Research Group to conduct the clinical evaluation. We evaluated complications in an early phase (day 0-30) and late phase (day 31 and after), the site of the mass, type of stent, technical and clinical success rates of stenting, whether there were any complications, changes in the CROSS scores as a reduced pressure effect, and the duration of stent patency. Median age was 80 years (62-93 years), and there were 12 males (60%). The site of the mass was the ascending colon in 3 cases, transverse colon in 4 cases, descending colon in 3 cases, and sigmoid colon and rectum in 5 cases each. The type of stent used was a covered stent in all cases. The technical success rate was 100%, and the clinical success rate was 89%. There was an early-phase complication in 2 cases; it consisted of a perforation in both cases, and in both cases stent placement was in the ascending colon. There was a late-phase complication in 3 cases; it consisted of recurrent obstruction in all 3 cases, and the cause was occlusion by an increase in size of the mass, not occlusion by a valve. When the early-phase complication cases were excluded, the mean CROSS scores tended to improve, rising from 3 points before stenting to 4 points after stenting, and the mean oral feeding resumption date was 2 days (0-4 days) after the procedure. The median average duration of stent patency of the patients stented 1 month or more was 148 days (35-1634 days), and there was even a patient whose stent was still patent after more than 4 years. The success rate of stenting for MCO was very high, and it was a safe treatment. We concluded that palliative colonic stenting for MCO is very useful in our super-aged society, and that it improves life expectancy and quality of life.