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Stenting in malignant colonic obstruction—is it a real therapeutic option?

  • Original Article
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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Malignant colonic obstruction is commonly treated surgically. Colonic stents are a therapeutic option for palliation or used as a bridge to surgery or chemotherapy.

Objective

The aim of the study was to evaluate the clinical success rate of stenting as a bridge to one-step surgery, chemotherapy, or as a palliative measure.

Design

This was a retrospective observational study.

Settings

The study was conducted at a university-affiliated tertiary referral center.

Patients and interventions

From 2007 to 2014, 45 patients with malignant colonic obstruction were referred for stent insertion.

Main outcome measures

Patients were grouped according to three pre-defined treatment goals: group 1: restorative one-step procedure without an ostomy, group 2: completion of scheduled chemotherapy before surgery, and group 3: palliation without surgical intervention.

Results

Group 1 included 11 patients. Three patients (27.3 %) met the treatment goal of one-step surgery. Eight patients (72.7 %) did not reach the primary goal due to stent insertion failure (four patients), stent-related complications (two patients), and failure to perform a one-step surgery after successful stent insertion (two patients). Group 2 included 12 patients. Chemotherapy was successfully completed prior to surgery in six patients (50 %). Six patients (50 %) did not achieve treatment goal due to stent insertion failure (two patients), stent migration (two patients), stent-related perforation (one patient), and mortality (one patient). Group 3 included 20 patients. Long-term palliation without surgical intervention was achieved in eight patients (40 %). Stent insertion failed in seven patients (35 %). Five patients (25 %) needed urgent surgery due to stent complications (three migrations and two perforations).

Limitations

The study was limited by its retrospective nature and small sample size.

Conclusions

This study demonstrates only a modest success rate of colonic stents in the treatment of malignant colonic obstruction. Although colonic stenting seems to be an effective method of relieving colonic obstruction, high failure rates limits its applicability.

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Acknowledgments

The authors thank Moshe Rubin, M.D. for his assistance and valuable comments.

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, 52621, Tel-Aviv, Israel

      Nir Horesh, Joseph Yosef Dux, Oded Zmora, Mordechai Gutman & Ron Shapiro

    2. Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

      Moshe Nadler & Alon Lang

    3. Institute Of Oncology, Sheba Medical Center, Tel-Hashomer, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

      Einat Shacham-Shmueli

    Authors
    1. Nir Horesh
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    2. Joseph Yosef Dux
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    4. Alon Lang
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    Corresponding author

    Correspondence to Ron Shapiro.

    Additional information

    Nir Horesh and Joseph Dux contributed equally to this work.

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    Horesh, N., Dux, J.Y., Nadler, M. et al. Stenting in malignant colonic obstruction—is it a real therapeutic option?. Int J Colorectal Dis 31, 131–135 (2016). https://doi.org/10.1007/s00384-015-2375-7

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    • DOI: https://doi.org/10.1007/s00384-015-2375-7

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