Abstract
Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance.
Highlights
Primary or recurrent adenocarcinoma, pelvic malignancies, and metastatic diseases can lead to the development of malignant colorectal strictures
self-expanding metal stents (SEMS) were placed with palliative intent in 19 patients and as a bridge to surgery in 2 (Table 1)
Two SEMSs were placed in 4 patients, because of long strictures/malpositioning of first stent
Summary
Pelvic malignancies, and metastatic diseases can lead to the development of malignant colorectal strictures. Up to 85% of acute colonic obstructions are due to malignancy and between 8% and 28% of patients with colonic cancer present with obstructive symptoms [1]. Traditional management of symptomatic malignant colorectal obstruction involves emergency colostomy. Patients with acute or chronic large bowel obstruction are usually high-risk surgical candidates due to poor general health. In 1991, Dohmoto [3] reported the first use of selfexpanding metallic stents (SEMSs) for palliation of colorectal cancer. A growing number of reports and reviews have demonstrated the effectiveness of SEMSs for palliation in patients with advanced nonresectable carcinoma and as a bridge to surgery in those patients with resectable disease [4,5,6,7]
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