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Outcome and safety of self-expandable metallic stents for malignant colon obstruction: a Korean multicenter randomized prospective study

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Abstract

Background

Newly developed uncovered stents are designed to have varied radial force and high conformability to improve clinical outcome and safety. This study aimed to determine and compare the clinical outcome and safety of the Taewoong D-type uncovered stent and the Boston Scientific Wallfex stent.

Methods

Patients with acute malignant colonic obstruction were treated with a colonic stent. For the purpose of palliation, patients were randomly allocated. For the purpose of bridging, the type of stent was determined by the discretion of the individual doctors. Technical and clinical success and complication occurrence were measured as primary outcomes.

Results

From 12 university hospitals, 123 patients with malignant colonic obstruction were enrolled. Of these 123 patients, 58 were treated with colonic stents for palliative purposes. The technical and clinical success rate was 100 % for both stents in the palliative group. Perforation occurred for one patient (3.6 %) in the Wallflex stent group (n = 28) on day 5 and for no patients in the D-type stent group (n = 30). Two cases of migration occurred: one with the Wallflex stent and one with the D-type stent. Stent restenosis occurred for one patient with the Wallflex stent. Preoperative bridging stents were placed in 65 patients. The median time to surgery was 10 days. The technical success rate was 93.4 %, and clinical success was achieved for 86.2 % of the patients. Perforation occurred for five patients: four with the Wallflex stent and one with the D-type stent. The efficacy and safety of the two stents did not differ statistically.

Conclusions

The D-type colonic uncovered stent and the Wallflex colonic uncovered stent are effective and safe for both palliative and preoperative bridging therapy used to treat acute malignant colonic obstruction.

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References

  1. Jemal A, Siegel R, Xu J et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300

    Article  PubMed  Google Scholar 

  2. Ferlay J, Shin HR, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917

    Article  PubMed  CAS  Google Scholar 

  3. Dutton JW, Hreno A, Hampson LG (1976) Mortality and prognosis of obstructing carcinoma of the large bowel. Am J Surg 131:36–41

    Article  PubMed  CAS  Google Scholar 

  4. Barillari P, Aurello P, De Angelis R et al (1992) Management and survival of patients affected with obstructive colorectal cancer. Int Surg 77:251–255

    PubMed  CAS  Google Scholar 

  5. Carraro PG, Segala M, Cesana BM et al (2001) Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 44:243–250

    Article  PubMed  CAS  Google Scholar 

  6. Cassidy J, Clarke S, Daz-Rubio E et al (2008) Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 26:2006–2012

    Article  PubMed  CAS  Google Scholar 

  7. Kim JS, Hur H, Min BS et al (2009) Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 33:1281–1286. doi:10.3748/wjg.v17.i28

    Article  PubMed  Google Scholar 

  8. Saltz LB, Clarke S, Daz-Rubio E et al (2008) Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 26:2013–2019

    Article  PubMed  CAS  Google Scholar 

  9. Andre T, Louvet C, Maindrault-Goebel F et al (1999) CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic colorectal cancer. GERCOR. Eur J Cancer 35:1343–1347

    Article  PubMed  CAS  Google Scholar 

  10. Kabbinavar F, Hambleton J, Mass RD et al (2005) Combined analysis of efficacy: the addition of bevacizumab to fluorouracil/leucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 23:3706–3712

    Article  PubMed  CAS  Google Scholar 

  11. Van Cutsem E, Twelves C, Cassidy J et al (2001) Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 19:4097–4106

    PubMed  Google Scholar 

  12. Tejero E, Mainar A, Fernndez L et al (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37:1158–1159

    Article  PubMed  CAS  Google Scholar 

  13. Keen RR, Orsay CP (1992) Rectosigmoid stent for obstructing colonic neoplasms. Dis Colon Rectum 35:912–913

    Article  PubMed  CAS  Google Scholar 

  14. Vemulapalli R, Lara LF, Sreenarasimhaiah J et al (2010) A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. Dig Dis Sci 55:1732–1737

    Article  PubMed  Google Scholar 

  15. Tilney HS, Lovegrove RE, Purkayastha S et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  PubMed  CAS  Google Scholar 

  16. Repici A, Fregonese D, Costamagna G et al (2007) Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc 66:920–927

    Article  PubMed  Google Scholar 

  17. Bretagnol F, Panis Y, Rullier E et al (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868

    Article  PubMed  Google Scholar 

  18. van Hooft JE, Fockens P, Marinelli AW et al (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40:184–191

    Article  PubMed  Google Scholar 

  19. Martinez-Santos C, Lobato RF, Fradejas JM et al (2002) Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406

    Article  PubMed  Google Scholar 

  20. Watt AM, Faragher IG, Griffin TT et al (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30

    Article  PubMed  Google Scholar 

  21. Park S, Cheon JH, Park JJ et al (2010) Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study. Gastrointest Endosc 72:304–310

    Article  PubMed  Google Scholar 

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Disclosures

Dae Young Cheung, Jin Yong Kim, Sung Pil Hong, Min Kyu Jung, Byong Duk Ye, Sang Gyun Kim, Jin Hong Kim, Kang Moon Lee, Kyung Ho Kim, Gwang Ho Baik, Ho Gak Kim, Chang Soo Eun, Tae Il Kim, Sang Woo Kim, Chang Duck Kim, and Chang Heon Yang have no conflicts of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. The Catholic University of Korea College of Medicine, Seoul, Korea

    Dae Young Cheung, Kang Moon Lee & Sang Woo Kim

  2. Sungkyunkwan University School of Medicine, Seoul, Korea

    Jin Yong Kim

  3. Yonsei University College of Medicine, Seoul, Korea

    Sung Pil Hong & Tae Il Kim

  4. Kyungpook National University School of Medicine, Daegu, Korea

    Min Kyu Jung

  5. University of Ulsan College of Medicine, Seoul, Korea

    Byong Duk Ye

  6. Seoul National University College of Medicine, Seoul, Korea

    Sang Gyun Kim

  7. Ajou University School of Medicine, Suwon, Korea

    Jin Hong Kim

  8. Hallym University College of Medicine, Chuncheon, Korea

    Kyung Ho Kim & Gwang Ho Baik

  9. Catholic University of Daegu School of Medicine, Daegu, Korea

    Ho Gak Kim

  10. Hanyang University College of Medicine, Seoul, Korea

    Chang Soo Eun

  11. Korea University College of Medicine, Seoul, Korea

    Chang Duck Kim

  12. Department of Internal Medicine, Dongguk University College of Medicine, 707 Sukjang-dong, Kyongju, Kyongbuk, 780-714, Korea

    Chang Heon Yang

Authors
  1. Dae Young Cheung
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  2. Jin Yong Kim
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  3. Sung Pil Hong
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  4. Min Kyu Jung
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  5. Byong Duk Ye
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  6. Sang Gyun Kim
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  7. Jin Hong Kim
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  8. Kang Moon Lee
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  9. Kyung Ho Kim
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  10. Gwang Ho Baik
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  11. Ho Gak Kim
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  12. Chang Soo Eun
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  13. Tae Il Kim
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  14. Sang Woo Kim
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  15. Chang Duck Kim
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  16. Chang Heon Yang
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Corresponding author

Correspondence to Chang Heon Yang.

Additional information

This study was conducted on behalf of the Korean Society of Gastrointestinal Endoscopy Stent Research Group. The members of this study group are listed in the appendix.

Appendix: Korean Society of Gastrointestinal Endoscopy Stent Research Group

Appendix: Korean Society of Gastrointestinal Endoscopy Stent Research Group

Dae Young Cheung, Jin Yong Kim, Sung Pil Hong, Min Kyu Jung, Byong Duk Ye, Sang Gyun Kim, Jin Hong Kim, Kang Moon Lee, Kyung Ho Kim, Gwang Ho Baik, Ho Gak Kim, Chang Soo Eun, Tae Il Kim, Sang Woo Kim, Young Soo Park, Jong Jae Park, Eun Taek Park, Chang Hwan Park, Ho June Song, Hoon Jai Chun, Young Deok Cho, Sang Woo Cha, Chang Duck Kim, and Chang Heon Yang.

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Cheung, D.Y., Kim, J.Y., Hong, S.P. et al. Outcome and safety of self-expandable metallic stents for malignant colon obstruction: a Korean multicenter randomized prospective study. Surg Endosc 26, 3106–3113 (2012). https://doi.org/10.1007/s00464-012-2300-x

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  • DOI: https://doi.org/10.1007/s00464-012-2300-x

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