The Role of Colonic Stents in Obstructive Metastatic Colorectal Cancers

Abstract

Purpose. Self-expandable metallic stents (SEMS) have been widely used in obstructive lesions. They are an alternative treatment for obstructive colorectal tumors. In this article, we retrospectively review our experience with placement of colonic stents for palliative treatment of obstructive metastatic colorectal cancers and inoperable colorectal cancers. Methods. From March 2004 to March 2007, we inserted SEMS in 15 patients. A retrospective chart review was undertaken at the China Medical University Hospital. For all patients, surgical treatment was not considered initially or the patients refused surgery. We analyzed the technical and clinical success rates of stent placement. All patients were characterized in terms of age, localization of tumor, complications, morbidity and mortality, and the necessity for further interventions. Results. Our subjects included eight males and seven females, with a mean age of 66 years (range 42-94 years). Sites of the lesion included six upper rectum, four rectosigmoid junction, three sigmoid colon , one descending colon , and one splenic flexure of colon. The stents were successfully implanted in 12 of the 15 patients and bowel obstruction relieved in all patients; the technical success rate was 80% and clinical success rate was 60%. Two patients with stent related perforations required emergency operation on the 4th or 18th day after stent implantation. The mean survival time (stent implantation to death) of the ten stage IV patients (n=10) was 7 months (range 1-16months). Four patients had complications. In general, there was no stent-related mortality. Conclusions. Self-expandable metallic stents in patients with malignancy- induced colorectal obstruction is technically feasible, but it has higher morbidity rate in our study. Colonic stent is an alternative option in treatment of obstructed colorectal malignancy, but is not encouraged for every patient. When use of SEMS, surgeon or gastroenterologist should evaluate the clinical benefits and cost effectiveness for the patient.