Self-expandable Metal Stent Insertion Research Articles

Comparison of Wallflex® and Comvi® Stents for Malignant Colorectal Obstruction: A Randomized Prospective Controlled Study

Background: Colonoscopic insertion of self-expandable metallic stent (SEMS) has been widely performed for the treatment of malignant colorectal obstruction. Different type of stents such as covered or uncovered one could influence the patency and complication rate of stents. However, there have been few studies concerning the comparison of efficacy between covered and uncovered stent. Aims and Methods: The aim of this randomized controlled study was to compare the efficacy and patency between two SEMS, i.e., uncovered WallFlex® stent by Boston Scientific and newly developed covered Comvi® stent which surrounded by PTFE (poly tetra fluoro ethylene) by TaeWoong medical Co. Consecutive patients with malignant colorectal obstruction were enrolled between Aug, 2005 and Aug, 2008 at Yonsei University College of Medicine, Seoul, Korea. Results: The total number of 100 patients was included in this study and their pre-procedural clinical characteristics and post-procedural outcomes were evaluated. Demographic characteristics such as sex, age, site, purpose of stent insertion, cause of obstruction were not significantly different between the 2 groups. Among them, fifty seven patients (57%) were treated by WallFlex® stent and forty three patients (43%) by Comvi® stent. Technical failure was developed in 2 patients (2%) who were included in Comvi® group, and clinical failure in 4 patients (4%). In one third of patients (32%), stent insertion was aimed for the bridge to operation, and in two thirds of patients (68%), for the palliation of obstruction. Complications due to cancer infiltration occurred more frequently in the group of WallFlex® stent (20% vs. 7.6%). However, the rate of stent migration was higher in Comvi® group (30% vs. 2.5%). The median patency duration of stent was not different between the 2 groups. Conclusions: Both uncovered WallFlex® and covered Comvi® stents were suitable to relieve malignant colorectal obstruction. Tumor ingrowth was more common in WallFlex® group but stent migration was more frequent in covered Comvi® group.

Chemotherapy After Stenting Is Feasible for Metastatic Gastric Cancer with Pyloric Stenosis

Background: Although surgical treatments such as gastrojejunostomy is the standard palliative treatment for unresectable gastric cancer with gastric outlet obstruction (GOO), self-expandable metallic stent (SEMS) placement has been recently accepted as palliative therapy for those. Chemotherapy for advanced gastric cancer has been positively performed because new drugs such as S-1, irinotecan and taxanes show high response rates. However, data are lacking for chemotherapy after SEMS insertion. This study retrospectively compared results between surgery plus chemotherapy and stenting plus chemotherapy for metastatic gastric cancer with GOO. Patients and Methods: Subjects comprised 26 patients who received chemotherapy after surgery or endoscopic stenting for metastatic gastric cancer with pyloric stenosis between April 2000 and December 2007 in 4 Japanese hospitals. Patients were categorized into 2 groups: 15 patients who underwent surgery for pyloric stenosis and received chemotherapy (Surgery group); and 11 patients with SEMS placement for pyloric stenosis who received chemotherapy (Stent group). Results: No significant differences were noted between Surgery and Stent groups in terms of gender ratio, median age, PS, histological type, location and number of metastases, first-line chemotherapeutic regimen and number of chemotherapeutic regimens used. Median survival time and median time to treatment failure (TTF) were 284 days and 226 days in the Surgery group and 337 days and 247days in the Stent group, respectively. No significant differences were noted between in survival and TTF. No significant differences were found in median oral intake rate (Surgery, 93.1%; Stent, 93.2%) or median hospital stay rate (Surgery, 24.6%; Stent, 23.7%) during survival. Response rate was 45.5% in the Surgery group and 50% in the Stent group, with no significant difference. Likewise, no significant differences were noted between groups for frequencies of toxicity or complications. Conclusions: The present results suggest that chemotherapy after stenting is as effective and safe as chemotherapy after surgery. Stents may replace surgery in combination therapy with chemotherapy for metastatic gastric cancer with GOO.

Comparison of Effects of Preoperative Stenting for Obstructing Colorectal Cancers according to the Location of the Obstructing Lesion

With the development of self-expanding metallic stents, colonic obstruction can be relieved without the need for surgery. The results of preoperative placement of stents for malignant colorectal obstruction might be different according to the obstructing lesion. The objective of this study was to compare clinical improvement rates and operative results after preoperative placement of stents for malignant colorectal obstruction according to the location of the obstructing lesion. This is a retrospective study including 57 patients who underwent self-expanding metallic stent insertion for obstructing resectable colorectal cancers. Patients were classified into three groups according to the location of the lesion as follows: proximal to the sigmoid colon (Group A), sigmoid colon (Group B), and rectum (Group C). The number of patients in A, B, and C groups was 13, 22, and 22, respectively. No significant differences in age, gender, stent type, and accompanying diseases among the three groups were observed. There were no significant differences in stent-related complications, clinical improvement rates, and one-stage resection rates among the three groups. The postoperative complications, the requirement rate of ICU care, the period of ICU stay, postoperative hospital stay, and hospital mortality did not significantly differ among the three groups. Clinical improvement rates and operative results after successful placement of stents for obstructing resectable colorectal cancers are not different according to the location of the obstructing lesion, suggesting that preoperative stenting for one-stage curative resection is useful, irrespective of the location of lesion.

Adoption of Self-expanding Metallic Stents in the Palliative Treatment of Obstructive Colorectal Cancer—Look Out for Perforations!

Self-expanding metallic stents (SEMSs) are increasingly used for the palliative treatment of inoperable colorectal cancer. The aim of the current study was to analyze the safety and efficacy of SEMS in the palliative treatment of obstructive colorectal cancer. Between 2003 and 2006, SEMS placement was attempted in 26 patients suffering from inoperable obstructive colorectal cancer. The recovery of the patients and the outcome of this treatment modality were analyzed prospectively. SEMS was successfully inserted in 19 (73%) of 26 patients. In 16 (84%) of these 19 cases, the placement of SEMS was the definitive treatment of colorectal obstruction and no additional surgical palliation was needed. There were 3 (16%) colonic perforations related to stent application. SEMS insertion seems to be an effective alternative in the palliative treatment of patients with malignant colorectal obstruction. However, perforation is a dangerous complication of the procedure.

Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center

A significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management. Our purpose was to review the management and outcomes of patients with biliary SEMS occlusion. Retrospective chart review at a single tertiary care hospital. From January 1999 to October 2005, a total of 90 patients had SEMSs placed for malignant biliary obstruction, and 27 of these occluded. Technical success of treating SEMS occlusion, stent patency and need for reintervention, and incremental cost analysis. A total of 60 ERCPs were performed to treat SEMS occlusions in 27 patients. The success rate was 95%; however, 52% of patients eventually required more than 1 intervention. Placing a second SEMS through the existing SEMS (n = 14) provided the lowest reocclusion rate (43% vs 55% and 100%), the longest time to reintervention (172 days vs 66 and 43 days, P = .03), and a trend toward longer survival (285 days vs 188 and 194 days) compared with plastic stent and mechanical balloon cleaning, respectively. Incremental cost analysis showed both uncovered SEMSs and plastic stents to be cost effective strategies. Small number of patients, retrospective study. Treatment of biliary SEMS occlusion with SEMS insertion provides for longer patency and survival, decreases the number of subsequent ERCPs by 50% compared with plastic stents, and is cost-effective.

Tratamiento paliativo de la obstrucción tumoral del vaciamiento gástrico con prótesis metálicas autoexpandibles insertadas endoscópicamente

the insertion of self-expanding metal stents to palliate malignant gastric outlet obstruction is a minimally invasive procedure that is being increasingly used. We discuss experience with this technique in a level-II hospital in the Spanish National Health System. a retrospective five-year study (2003-2007) was conducted in 23 patients who underwent 27 procedures aimed at resolving malignant gastric outlet obstruction (mean, 0.45 procedures per month) using endoscopically inserted noncovered stents (Wallstent and Wallflex). insertion was technically feasible in all 27 (100%) attempts, with satisfactory clinical results in 25 cases (92.5%). Endoscopy alone was used 10 times (37%), and both endoscopy and fluoroscopy on 17 (63%) occasions. After stent insertion, one patient was intervened for treatment, and a patient with an unsuccessful prosthesis received a palliative surgical bypass. Four stents became obstructed by tumoral ingrowth, and patency was reestablished by inserting a new stent. Obstructive jaundice caused by stents covering the papilla of Vater occurred in three cases. There were no other complications or mortality due to the procedure. Mean survival was 104 days (range 28-400, SD +/- 94). in our experience endoscopic insertion of self-expanding metal stents appears to be a safe and efficient palliative method for malignant gastric outlet obstruction, and can be performed successfully in a center with our characteristics.

Clinical outcome of simultaneous endoscopic self-expandable metal stent insertion for palliation malignant biliary and duodenal obstruction

Background and study aims: Previous studies have shown that self-expandable metal stents/SEMS/are an effective method for palliation of malignant biliary and duodenal obstruction. Combined biliary and duodenal stenting remains a technical challenge, however. The aim of this study was to evaluate the technical feasibility of an endoscopic approach to double stenting of malignant biliary and duodenal strictures.

Comparison of Uncovered and Covered Stent for Endoscopic Treatment of Inoperable Malignant Gastroduodenal Obstruction

Background: Self-expandable metallic stents (SEMS) insertion has been simple, safe, and effective palliative treatment for malignant gastric outlet obstruction. Uncovered stents has been reported to have a high rate of tumor ingrowth and covered stents have the disadvantage of stent migration. In most of studies about covered stent, stents were inserted with non-endoscopic method. There has been no comparison study of endoscopic insertion of covered and uncovered stent for malignant gastroduodenal obstruction.

Endoscopic Re-Intervention for the Management of Dysfunction of Covered Metallic Stents in Patients with Malignant Distal Biliary Obstructions

Background: Covered self-expandable metallic stents (CMSs) are widely used for the palliation of unresectable malignant distal biliary obstruction. Although short- and long-term results of the initial CMS have been evaluated, management and outcome of the dysfunctional CMS have not been addressed. Methods: Between April 1996 and May 2007, 102 patients who had received a CMS placement for the treatment of malignant distal biliary obstructions developed stent dysfunction requiring re-interventions. Of these, 81 patients (56% men; mean age, 69 years) in whom stent dysfunction was endoscopically treated were included in the present study. Patients were divided into 4 groups according to the type of re-intervention employed; CMS insertion (n = 37), plastic stent (PS) insertion (22), cleaning (17), and uncovered self-expandable metallic stent (UMS) insertion group (5). Short- and long-term outcomes of re-interventions were evaluated and compared among the 4 groups. The success of re-intervention was defined as no evidence of cholangitis or jaundice within 14 days after the procedure. The patency period of the re-interventon was calculated as the interval between the re-intervention and its dysfunction or the patient's death. Results: The first CMSs were occluded 86 days (median; range, 0 - 556) after their placement due to sludge occlusion (n = 42), stent migration (21), tumor overgrowth (14), and kinking (4). The failure of the re-intervention occurred in 4 patients (two in the PS, and one each in the CMS and in the UMS group). Removal of the first CMSs was attempted using forceps and polypectomy snears in 40 patients, and successful removal was achieved in 37 patients (93%). The median patency periods after re-interventions in the CMS, the PS, the cleaning, and the UMS group were 176, 38, 34, and 173 days, respectively. The cumulative patency rate was significantly higher in the CMS group than in the PS group (p = 0.0030) and the cleaning group (p = 0.0030). Cox-proportional hazard model identified two risk factors for short stent patency of re-intervention; sludge occlusion of the initial CMS and insertion of PSs. During follow-up period, acute cholecystitis occurred in two patients (one each in the UMS and in the PS group), and one patient in the UMS group developed liver abscess. There was no significant difference with regard to survival among 4 groups. Conclusion: Placement of a new CMS should be considered as the treatment of choice for dysfunction of CMSs. As sludge occlusion of the initial CMSs may be associated with the short patency of the stent after re-intervention, further strategies are mandatory in this group of patients.

Comparison of short-and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction

Self-expanding metallic stents (SEMS) are now regarded as a safe and effective treatment for an acute obstructing colorectal cancer. SEMS insertion is an invasive procedure that could potentially worsen prognosis. This study assessed the short-and long-term outcomes in patients stented for acute large bowel obstruction and in patients who underwent primary emergency surgery. We retrospectively identified 19 patients who underwent SEMS insertion and 23 patients who had primary emergency surgery for left-sided large bowel obstruction as the first presentation of colorectal cancer. There were no significant differences between the 19 patients in the SEMS group and the 23 patients in the primary emergency surgery group in terms of demographics and tumour location and stage. Stent insertion was successful in 16 patients (84%). One patient died from a stent-related perforation and another had a stoma fashioned for stent migration. Stents were a definitive procedure in 2 patients with advanced disease and acted as a "bridge to surgery" in the remaining 12 patients. Compared to the primary surgery group, there was a trend towards a higher primary anastomosis rate in the SEMS group (p=0.08); there were no significant differences in length of hospital stay, 30-day mortality or complication rates between the groups. Long-term prognosis (estimated 3-year survival) did not differ significantly between the groups (p=0.54); this persisted when only curative resections were considered (p=0.80). Preoperative stent insertion is a safe and effective treatment for large bowel obstruction, and may result in a higher primary anastomosis rate. Stent insertion does not seem to have a deleterious effect on prognosis.

A Covered Nitinol Stent Fracture in a Patient with a Malignant Esophageal Stricture: A Case Report

Self-expanding metallic stent insertion has been widely applied for the palliative treatment of malignant esophageal strictures. Although it is known as an easy, safe, and effective procedure, complications are well known and include things such as stent migration and esophageal stent occlusion caused by tumor ingrowth. However, metallic stent fractures have been rarely reported in the esophagus, especially for nitinol stents. We report a case of a stent fracture associated with migration in a patient with a malignant esophageal stricture near the gastroesophageal junction. It is highly probable that the stent fracture was due to chemical erosion of the stent caused by gastric juice.

Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction

Insertion of self-expandable metallic stents (SEMS) can provide rapid relief of malignant colorectal obstruction and can be used as a palliative treatment or as a bridge to surgery. A SEMS can be classified as an uncovered or covered stent. Both types of stents have their own merits and demerits. The objectives of this study were to compare success rates, durability, and complication rates of uncovered and covered stent groups of malignant colorectal obstruction. DESIGNS AND SETTING: A nonrandomized prospective, single-center study. We studied 80 patients with malignant colorectal obstruction: colon cancer in 70 patients, metastatic lesion of advanced gastric cancer in 8 patients, and cervix cancer in 2 patients. Insertion of uncovered stents was attempted in 39 patients (before surgery in 20, palliative in 19), and covered stents were used in 41 (before surgery in 23, palliative in 18). The stent was inserted into the obstructive sites for preoperative or palliative purposes by using the through-the-scope method. After stent insertion, the patients had regular follow-ups, either as clinical checkups or telephone interviews. Insertion success rate, durability, and complication rate according to stent type. Technical and clinical success rates of uncovered and covered stents were not different (100%; 95.1%, P > .05, 100%; 97.4%, P > .05). The early stent migration rate was not different in both groups. The late stent migration was more common in the covered stent group than the uncovered stent group (0% vs 40%, respectively, P = .005). Loss of stent function during the long-term follow-up period was more frequent in the covered stent group than in the uncovered stent group (18.8% vs 60%, respectively, P = .018). This was a small-sized, nonrandomized, prospective, single-center study. Confirmation of large-scale, multicenter, randomized, prospective outcome is required. Insertion of either an uncovered or covered stent is similarly an effective treatment modality of malignant colorectal obstruction for preoperative purposes. However, there are no advantages of covered stents over uncovered stents during the follow-up period in the palliative purpose.

A New Method of Endoscopic Stent Insertion for Gastrointestinal Luminal Stenosis Without Fluoroscopic Assistance

Background & Aim: Endoscopic insertion of self-expanding metal stents (SEMS) is usually performed under fluoroscopic monitoring. Endoscopists sometimes encounter difficulties in using or accessing fluoroscopy facilities. This study was aimed at describing a new method of SEMS insertion using only endoscopic control, including the measurement of the stricture length by balloon retrieval maneuver, and also we compared the results of new method with traditional fluoroscopic monitoring method. Method: A total 37 patients, who had endoscopic SEMS positioned due to malignant obstruction, were retrospectively evaluated; 25 insertions were done with the fluoroscopic monitoring and 12 were inserted with a new endoscopic method without fluoroscopic monitoring. A new method had also advantages as prevention of twisting of the guide-wire. The first step in the insertion of SEMS without fluoroscopic monitoring begun with traversing the malignant stricture using a guide-wire induced balloon catheter. The balloon catheter was inserted as far as possible past the stenosis; air inflated balloon catheter was then slowly retrieved; the length of stenosis was measured with marking; and adequate length of SEMS was inserted in that order. Results: Successful insertion was achieved and obstruction was abolished in all patients of both group (100%) and there was no treatment-related mortality. But, 3 patients (1 of fluoroscopic monitoring group and 2 of new method group) experienced stent migration and 5 patients experienced tumor overgrowth (4 of fluoroscopic monitoring group and 1 of new method group). There were no statistical differences in successful rate, the median duration of hospitalization and complication rate between two groups. Conclusion: This method of endoscopic stent insertion without fluoroscopic monitoring could be useful and safe alternative to the current method using the fluoroscopic monitoring.

Endoscopic removal of biliary self-expandable metallic stents: a prospective study

The transpapillary endoscopic insertion of self-expandable metallic stents (SEMSs) has been widely used for the palliation of unresectable malignant biliary obstruction. We attempted the endoscopic removal of malfunctioning SEMSs. The aim of this study was to assess the feasibility and safety of the endoscopic removal of SEMSs by comparing the results between removal of covered and uncovered SEMSs. 30 patients with a malfunctioning biliary SEMS prospectively underwent an attempt at endoscopic removal of the biliary SEMS over a 2-year period. Removal of the malfunctioning SEMS was done with a therapeutic duodenoscope (ED-450XT5 or TJF-240), using a rat-tooth forceps. Of the 30 SEMS used, 22 were silicone-covered Wallstents, while eight were uncovered SEMSs including five uncovered Wallstents and three Zilver stents. The time for an attempt at each endoscopic removal was limited to 15 minutes in a single endoscopic procedure session. The covered SEMSs were easily removed in 19 out of 22 patients (86.4 %), whereas none of the eight uncovered SEMSs (0 %) could be removed. The only factor predicting successful stent removal was the presence of a stent covering ( P = 0.000). There was no morbidity or mortality related to endoscopic removal of malfunctioning stents. In contrast to uncovered biliary SEMSs, in most cases malfunctioning covered biliary SEMSs can be easily and safely removed endoscopically using a rat-tooth forceps.

Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer

Self-expanding metallic stents (SEMS) are a first-line therapeutic procedure in the palliative treatment of dysphagia in patients with esophageal cancer. However, the impact of SEMS insertion on patient nutritional status has never been assessed. To evaluate the nutritional status of patients after insertion of a SEMS and the impact of a preexisting undernutrition status on survival. Retrospective observational study. A total of 120 patients treated in a single center by insertion of a SEMS for relief of dysphagia in the palliative treatment of esophageal cancer were retrospectively included. Efficacy of SEMS was assessed by the Ogilvie's dysphagia score. Patient nutritional and clinical statuses were evaluated at SEMS insertion, and patients were regularly followed until death. Independent predictive factors of early 30-day mortality were researched. Dysphagia scores decreased after SEMS insertion in 89.1% of patients, with median scores decreasing from 3.0 to 1.0 (P < .05). There was a significant decrease in body mass index (BMI) (P < .04), serum albumin level (P < .01), and World Health Organization (WHO) performance index (P < .02) at a 1-month evaluation. Serum albumin level, BMI <18 kg/m(2), and WHO performance index >2 at SEMS insertion were independent predictive factors of 30-day mortality. This study suggested that palliative stent placement in esophageal cancer was effective to relieve dysphagia but was not followed by an improvement of nutritional parameters. Moreover, it underlined the key role played by undernutrition on survival.

Radiographer involvement with stent insertion to palliate symptomatic dysphagia resulting from neoplastic obstruction

Self-expanding metal stent (SEMS) insertion is recognized as an effective palliative treatment for patients with symptomatic dysphagia resulting from inoperable neoplastic occlusion. This paper reviews radiographer involvement in the fluoroscopic deployment of SEMS. One hundred and fifty-eight SEMS were passed in 136 consecutive patients. Radiographers were responsible for the barium swallow and subsequent passage of an oro-gastric wire across the strictured lumen. One hundred and twenty-seven guide wire insertions under fluoroscopic control transgressed the tumour lumen at first attempt. Nine (6.6%) guide wire insertions were unsuccessful at first attempt however two patients (2.7%) had successful second attempts at fluoroscopically guided wire insertion. Five patients went on to have a joint endoscopic/fluoroscopic SEMS procedure, three were successful, two failed. Due to poor health it was decided not to proceed with further intervention with two other patients. With an overall success rate of 96%, a joint radiographer/clinician approach to guide wire insertion and subsequent SEMS deployment using fluoroscopy alone is a safe, time- and cost-effective procedure.

Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer

BackgroundThe main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery.Patients and methodsAll the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS) were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation.ResultsOverall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93). The median number of sessions per patient was 2 (range 1 – 13 sessions). Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months) and the median survival from 1st palliation was 5 months (range 0.5–68.5 months).ConclusionEndoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

Insertion of colorectal self-expanding metal stents is a safe and effective option for relieving symptoms of malignant colorectal obstruction

Insertion of colorectal self-expanding metal stents is a safe and effective option for relieving symptoms of malignant colorectal obstruction

Prior chemoradiotherapy is associated with a higher life‐threatening complication rate after palliative insertion of metal stents in patients with oesophageal cancer

Self-expanding metal stents are used routinely to palliate dysphagia due to oesophageal cancer. To compare the frequency of life-threatening complications after self-expanding metal stent insertion, depending on whether patients received prior chemoradiotherapy or no treatment. During 7 years, 116 consecutive patients were treated at a single centre in a palliative intent by insertion of self-expanding metal stent for dysphagia due to an oesophageal cancer. Patients were retrospectively separated into two groups: patients with chemoradiotherapy before self-expanding metal stent insertion (group 1, n = 56) and patients with no treatment before or after self-expanding metal stent insertion (group 2, n = 60). Life-threatening complications were compared and predictive risk factors of postprocedure complications were identified. Median dysphagia was significantly improved during the first month (grade 3 to grade 1 in the two groups). Early and late major complications occurred more frequently in group 1 (23.2% vs. 3.3%; P < 0.002 and 21.6% vs. 5.1%; P < 0.02 respectively). Prior chemoradiotherapy was the only independent predictive factor of postprocedure major complications, with an odds ratio of 5.59 (CI 95% 1.7-18.1). Life-threatening complications after palliative self-expanding metal stent placement seem to occur more frequently in patients with prior chemoradiotherapy. Prevention of these severe complications should be considered before stenting.

Self-Expanding Metallic Stent as a Bridge to Surgery Versus Emergency Resection for Obstructing Left-Sided Colorectal Cancer: A Case-Matched Study

This study aimed to compare the outcomes of patients who suffered from obstructing left-sided colorectal cancer, treated with self-expanding metallic stent (SEMS) as a bridge to surgery, with those who underwent emergency operation. Twenty patients who had acute obstruction due to left-sided colorectal cancer underwent surgical resection after insertion of SEMS (group I) were matched to 40 patients with emergency colonic resection (group II). The two groups were compared for the incidence of primary anastomosis, stoma rate, hospital stay, duration of intensive care, postoperative morbidity, and mortality. Both groups had similar preoperative comorbidity and stage of disease, but the tumors in group I were more distally located (P < 0.001). In group I, one patient developed colon perforation and required Hartmann's operation. All the other patients underwent elective operation with primary anastomosis. In group II, primary anastomosis was performed in 29 patients (72.5%; P = 0.047). The operative mortality of group I and group II was 5% and 12.5%, respectively (P = 0.653). Significantly shorter median postoperative hospital stay and median stay in the intensive care unit (ICU) were observed in group I (9 days [range, 5-39 days] vs. 12 days [range, 8-49 days], P = 0.015 and 0 day [range, 0-17 days] vs. 0.5 day [range, 0-18 days], P = 0.022, respectively). There were no differences in hospital mortality (P = 0.653) or 30-day mortality (P = 0.653). Both groups had similar reoperation rates, surgical complications, and medical complications. When compared with emergency resection, insertion of SEMS as a bridge to surgery for obstructing left-sided colorectal cancer is associated with a higher rate of primary anastomosis as well as a better outcome in terms of hospital stay and stay in the ICU. The wider application of this treatment option for obstructing colorectal cancer warranted further studies.