Self-Expandable Metal Stents are Effective and Useful in the Management of Malignant Colorectal Obstruction

Abstract

Purpose: Self-expandable metal stents (SEMS) are increasingly used as a bridge to surgery (BTS) and as a palliative intention (PI) in patients presenting with obstructive colorectal cancer. Teh aim of the study was to determine the efficacy and outcome of SEMS in relieving colorectal obstruction due to neoplastic lesions Methods: We carried out a retrospective study in patients who underwent endoscopic placement of colorectal SEMS under fluoroscopic guidance between 2004 and 2007. Results: A total of 62 SEMS were placed in 58 patients, of which 34 were male patients. The average age was 72.2 ± 13.4 years. Twenty two patients presented with occlusive symptoms. Cancer types: Colorectal cancer- 56; Neoplastic colonic invasion –2 (uterus –1; urinary bladder –1). Stricture location: Sigmoid colon –39; Rectum –10; Descending colon –2; Splenic flexure –2; Transverse colon –2, Hepatic flexure −2; Ascending colon –1. Indication for SEMS placement: Palliative intention (PI) –44 patients; Bridge to surgery (BTS) –14 patients. Three patients in the PI group required a second SEMS placement: Stent obstruction due to tumour growth –2; Stent migration −1. SEMS types utilized: Ultraflex precision –17, Wallstent –17, Hanarostent –16, Wallflex –12. Technical and clinical success was achieved in 98.3% (57/58). Incomplete expansion and deployment of the SEMS occurred in one patient. Complications were detected in 13.8% (8) patients. Immediate complications (≤48 h of SEMS placement): Perforation –1; Colovesical fistula –1; Localized perforation resolved with conservative treatment −1. Late complications (>1 week after SEMS placement): Perforation –2; Stent obstruction by tumour in growth –2; stent migration −1. The late complications occurred between 19 –332 days after SEMS placement. There was no association between complications and the SEMS type utilized. Only one death occurred due to SEMS related perforation complicated by sepsis and multi-organ failure. The average time till surgery in the BTS patients was 22.6 ± 21.3 days. The average follow up period was 241.6 ± 275.7 days. During this period, there were 33 deaths: PI group –30; BTS group –3. With the exception of the patient who died from sepsis following colonic perforation, all of the deaths were related with the underlying neoplasia. Conclusion: SEMS are a safe and effective therapeutic option in colorectal obstruction due to neoplasia. Majority of the SEMS were used to palliate advanced colorectal cancer. The complications related to SEMS were relatively infrequent. SEMS should be considered as a bridge to surgery in patients with obstructive localized colorectal cancer who are not candidates for one-stage surgery with curative intent.