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Place des prothèses coliques dans la prise en charge du cancer colorectal

Endoscopic stenting for the management of colorectal cancer

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Oncologie

Résumé

Le traitement endoscopique par endoprothèse colique d’une occlusion colique liée à un cancer colorectal doit s’intégrer dans la stratégie thérapeutique globale de prise en charge du cancer. En situation curative, l’endoprothèse en pont avant la chirurgie ne peut pas être recommandée en première intention, et le traitement chirurgical de l’occlusion est à privilégier. Elle est une alternative thérapeutique dans les centres experts. En situation palliative, l’endoprothèse peut être recommandée en première intention. Elle réduit le recours à la stomie, la durée d’hospitalisation, la morbimortalité et le délai de début d’une chimiothérapie. Dans cette situation, la chirurgie est une autre option thérapeutique. Chez les patients avec une endoprothèse colique, l’utilisation d’un traitement antiangiogénique expose à un risque élevé de perforation.

Abstract

Endoscopic self-expandable metal stent placement is a minimally invasive option for achieving acute colonic decompression in obstructed colorectal cancer. Decisions about stent placement for obstructive colorectal cancer must consider the prognosis of the cancer and possible therapeutic strategy following the resolution of obstruction. In curative intent, stenting cannot be recommended as first-line intervention and the surgical treatment of occlusion is preferred. In the context of palliative intent, stenting can be recommended as a first-line intervention and surgery is an option. Treatment with a colonic stent reduces the rate of stoma, the duration of hospital stay, and morbidity and mortality; and permits rapid initiation of chemotherapy. Given the increased risk of colonic perforation, the anti-angiogenic treatment is not recommended in patients with a colonic stent.

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Authors and Affiliations

  1. Université François-Rabelais, 60, rue du Plat-D’Etain, F-37000, Tours, France

    T. Lecomte & M. Caulet

  2. Service d’hépatogastroentérologie et de cancérologie digestive, hôpital Trousseau, CHRU de Tours, avenue de la République, F-37170, Chambray-lès-Tours, France

    T. Lecomte, S. Féau & M. Caulet

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  1. T. Lecomte
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  2. S. Féau
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  3. M. Caulet
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Correspondence to T. Lecomte.

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Lecomte, T., Féau, S. & Caulet, M. Place des prothèses coliques dans la prise en charge du cancer colorectal. Oncologie 16, 593–598 (2014). https://doi.org/10.1007/s10269-014-2469-9

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  • DOI: https://doi.org/10.1007/s10269-014-2469-9

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