Placement of Self-Expanding Metal Stents for Acute Malignant Large-Bowel Obstruction in Patients with Metastatic Disease: A Single Center Experience

Abstract

Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. The purpose of this study was to review our single-center experience with self-expanding metal stents (SEMS) as the initial therapeutic approach in the management of patients with obstructing colon cancer and nonresectable metastatic disease. Methods: A retrospective review of patients with obstructing colon cancer who underwent a colonoscopy for insertion of a SEMS from 2004 to 2008 was performed. All patients received an uncovered WallFlex™ Colonic Stent (Boston Scientific, Natick, USA). The primary endpoint was relief of obstruction and patency of the stent allowing transit of colonic contents. Secondary endpoints include technical success, and early and long term complications. Results: We evaluated 38 patients (mean age 61.7 years, males 63%) with malignant colonic obstruction. Obstruction sites were rectum or sigmoid colon in 26 patients (68%), descending sigmoid colon in 6 (16%), transverse colon in 3 (8%), and ascending colon in 3 (8%). Technical success, defined as successful placement and expansion of the SEMS, was achieved in 36/38 (95%) patients. Clinical relief of obstruction happened in all patients when placement was technically successful. Post-procedural complications (<24 hours after SEMS placement) occurred in 3/36 (8%) patients: colonic perforation (2) and migration (1). Delayed complications occurred in 7/36 (19%) patients: reobstruction caused by impaction of feces(1), stent migration (2), and colon perforation (4). Reintervention was required in 5 patients: surgery (3) and repeat SEMS placement (2). The overall 6-month mortality rate was 34%. Conclusions: In patients with metastatic colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy. In most patients SEMS provides a minimally invasive alternative to surgical intervention.