Abstract
Endoscopic stenting with self-expandable metallic stents is widely accepted for the treatment of malignant colorectal obstruction. Generally, stenting is performed as a bridge-to-surgery for primary colorectal cancer (CRC). Furthermore, palliative colonic stenting is performed for extraparenteral malignant tumors (EPMTs). However, predictive factors for improving clinical outcomes after colonic stenting for EPMTs remain unclear. This study is aimed at evaluating patients with EPMTs who underwent colonic stenting and investigating factors influencing clinical improvement after the stenting procedure. Twenty-one patients with colorectal obstruction by EPMTs were treated using self-expandable metallic stents over a period of 8 years. We divided the enrolled patients into the clinically improved and nonimproved groups after colonic stenting. Variables, including age; sex; type of primary cancer; serum albumin level; location of the obstruction; stent type, length, and diameter; prior chemotherapy treatment; ascites; Eastern Cooperative Oncology Group performance status (PS); technical and clinical success rates; stent-related adverse events; and mortality rates, were evaluated. Technical failure was not observed in all cases. Clinical success, defined as the passage of stool and improvement in the colorectal obstruction scoring system (CROSS) without adverse events, was observed in the 14 patients. Univariate analyses revealed no significant differences in factors other than PS before stenting (P = 0.04) between the improved and nonimproved groups. Colonic stenting for EPMTs was effective. PS may be an independent risk factor of clinical outcomes after stenting.
Highlights
Colorectal obstruction occurs in 8%-13% of patients with colorectal cancer (CRC) [1]
Colonic stenting acts as a bridge-to-surgery (BTS) for primary CRC or as a palliative treatment of obstruction caused by extraparenteral malignant tumors (EPMTs), including metastases from primary tumors in the pancreas, breast, gynecologic organs, and stomach [2]
Clinical improvement was not observed in 33% (7/21) of patients
Summary
Colorectal obstruction occurs in 8%-13% of patients with colorectal cancer (CRC) [1]. Before the development of endoscopic self-expandable metallic stents (SEMSs), emergency surgeries were performed to treat colorectal obstruction. Colonic stenting acts as a bridge-to-surgery (BTS) for primary CRC or as a palliative treatment of obstruction caused by extraparenteral malignant tumors (EPMTs), including metastases from primary tumors in the pancreas, breast, gynecologic organs, and stomach [2]. Colonic stenting is effective to avoid emergency surgery and improve abdominal symptoms. Predictive factors for improving clinical outcomes after colonic stenting for EPMTs remain unclear. This retrospective cohort study is aimed at evaluating patients with colorectal obstruction by EPMTs who underwent colonic stenting and investigating the factors that affect clinical improvement after stenting
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