Palliative stent implantation in the treatment of malignant colorectal obstruction

  • H. Ptok
  • F. Meyer
  • F. Marusch
  • R. Steinert
  • I. Gastinger
  • H. Lippert
  • L. Meyer
Original Article

Abstract

Background

Palliative surgical interventions for the management of colonic obstruction in cases of metastasized or locally irresectable colorectal carcinoma show remarkable morbidity and mortality rates for mostly older and multimorbid patients. For manifest obstruction, placement of a self-expanding metal stent (SEMS) is considered to be a suitable minimally invasive therapeutic option. This study aimed to investigate the efficacy of stent-based treatment for malignant large bowel obstruction.

Methods

From January 1999 to June 2005, consecutive patients who had undergone placement of a SEMS for malignant colorectal obstruction were enrolled and monitored. Manifest incontinence and rectum carcinoma within 5 cm above the anocutaneous line were contraindications for SEMS implantation. For all further locations of tumor-induced stenosis, a stent was implanted using endoscopy and fluoroscopy. This case series was characterized in terms of age, carcinoma localization, complications, morbidity and mortality, and the necessity for further interventions.

Results

For 44 of 48 patients (92%), stents were placed successfully and obstruction was abolished. The four remaining patients experienced stent dislocation. The median of age of the patients was 77.7 years (range, 47–96 years). The distribution of malignant stenoses was as follows: rectum (n = 16, 33.3%), sigmoideal colon (n = 21, 43.8%), descending colon (n = 4, 8.3%), splenic flexure (n = 2, 4.2%), transversal colon (n = 3, 6.2%), hepatic flexure (n = 1, 2.1%), and ascending colon (n = 1, 2.1%). There was no peri-interventional morbidity or mortality. The median in situ time for the stents was 251 days (mean, 422 days), with 13 of 44 patients treated with palliative therapy showing complications (29.5%). Six patients were treated endoscopically, and three individuals underwent surgical intervention. For four patients, no further intervention was required. Overall, there was no treatment-related mortality.

Conclusions

For palliative treatment of malignancy-induced colorectal obstruction, SEMS is an efficient tool associated with low morbidity and minimal mortality. From a technical point of view, all tumor locations are accessible.

Keywords

Colonic obstruction Irresectable colorectal carcinoma Metastasized colorectal carcinoma Palliative surgical interventions Self-expanding metal stent SEMS 

References

  1. 1.
    Adler DG, Baron TH (2002) Endoscopic palliation of colorectal cancer. Hematol Oncol Clin North Am 16: 1015–1029PubMedCrossRefGoogle Scholar
  2. 2.
    Xinopoulos D, Dimitroulopoulos D, Tsamakidis K, Apostolikas N, Paraskevas E (2002) Treatment of malignant colonic obstructions with stent and laser. Hepatogastroenterol 49: 359–362Google Scholar
  3. 3.
    Harris GJC, Senagore AJ, Lavery IC, Fazio VW (2001) The management of neoplastic colorectal obstruction with colonic endoluminal stenting devices. Am J Surg 181: 499–506PubMedCrossRefGoogle Scholar
  4. 4.
    Fazio VW (2004) Indications and surgical alternatives for palliation of rectal cancer. J Gastrointest Surg 8: 262–265PubMedCrossRefGoogle Scholar
  5. 5.
    Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 34: 823–830PubMedCrossRefGoogle Scholar
  6. 6.
    Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis M, Posner MC (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135: 530–535PubMedCrossRefGoogle Scholar
  7. 7.
    Makela J, Haukipuro K, Laitinen S, Kairaluoma ML (1990) Palliative operations for colorectal cancer. Dis Colon Rectum 33: 846–850PubMedCrossRefGoogle Scholar
  8. 8.
    Liu SK, Church JM, Lavery IC, Fazio VW (1997) Operation in patients with incurable colon cancer: is it worthwhile? Dis Colon Rectum 40: 11–14PubMedCrossRefGoogle Scholar
  9. 9.
    Joffe J, Gordon PH (1981) Palliative resection for colorectal carcinoma. Dis Colon Rectum 24: 355–360PubMedGoogle Scholar
  10. 10.
    Keymling M (2003) Colorectal stenting. Endoscopy 35: 234–238PubMedCrossRefGoogle Scholar
  11. 11.
    Lee YM, Law WL, Chu KW, Poon RTP (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192: 19–25CrossRefGoogle Scholar
  12. 12.
    Johnson R, Marsh R, Corson J, Seymour K (2004) A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer. Ann R Coll Surg Engl 86: 99–103PubMedCrossRefGoogle Scholar
  13. 13.
    Bhardwaj R, Parker MC (2003) Palliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis 5: 518–521PubMedCrossRefGoogle Scholar
  14. 14.
    Xinopoulos D, Dimitroulopoulos D. Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, Gontikakis M, Kontis M, Paraskevas I, Vassilobpoulos P, Paraskevas E (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Surg Endosc 18: 421–426PubMedCrossRefGoogle Scholar
  15. 15.
    Maetani I, Tada T, Ukita T, Inoue H, Yoshida M, Saida Y, Sakai Y (2004) Self-expandable metallic stent placement as palliative treatment of obstructed colorectal carcinoma. J Gastroenterol 39: 334–338PubMedCrossRefGoogle Scholar
  16. 16.
    Dohmoto M (1991) New method: endoscopic implantation of rectal stent in palliation of malignant stenosis. Endoscopia Digestiva 35: 912–913Google Scholar
  17. 17.
    Carne PWG, Frye JNR, Robertson GM, Frizelle FA (2004) Stents or open operation for palliation of colorectal cancer: a retrospective cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 47: 1455–1461PubMedCrossRefGoogle Scholar
  18. 18.
    Kang SG, Jung GS, Cho SG, Kim JG, Oh JH, Song HJ, Kim ES (2002). The efficacy of metallic stent placement in the treatment of colorectal obstruction. Korean J Radiol 3: 79–86PubMedCrossRefGoogle Scholar
  19. 19.
    Aviv RI, Shyamalan G, Watkinson A, Tibballs J, Ogunbaye G (2002) Radiological palliation of malignant colonic obstruction. Clin Radiol 57: 347–351PubMedCrossRefGoogle Scholar
  20. 20.
    Seymour K, Johnson R, Marsh R, Corson J (2002) Palliative stenting of malignant large bowel obstruction. Colorectal Dis 4: 240–245PubMedCrossRefGoogle Scholar
  21. 21.
    Clark JS, Buchanan GN, Khawaja AR, Rowe PH, Stoodley BJ, Saunders MP, Anderson HJ (2003) Use of the Bard Memotherm self-expanding metal stent in the palliation of colonic obstruction. Abdom Imaging 28: 518–524PubMedCrossRefGoogle Scholar
  22. 22.
    Piccinni G, Angrisano A, Testini M, Bonomo GM (2004) Definitive palliation for neoplastic colonic obstruction using enteral stents: personal case series with literature review. World J Gastroenterol 10: 758–764PubMedGoogle Scholar
  23. 23.
    Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (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: 401–406PubMedCrossRefGoogle Scholar
  24. 24.
    Knöpfle E, Mayer H, Wamser G, Bohndorf K, Witte J (2001) Ileus in colorectal carcinoma: preoperative implantation of self-expanding metal stents and early elective surgery as an alternative to emergency surgery. Chirurg 72: 1137–1143PubMedCrossRefGoogle Scholar
  25. 25.
    Balagué C, Targarona EM, Sainz S, Montero O, Bendahat G, Kobus C, Garriga J, Gonzalez D, Pujol J, Trias M (2004) Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Dig Surg 21: 282–286PubMedCrossRefGoogle Scholar
  26. 26.
    Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P (2004). Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 47: 444–450PubMedCrossRefGoogle Scholar
  27. 27.
    Dauphine CE, Tan P, Beart RW, Vakusin P, Cohen H, Corman ML (2002) Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review. Ann Surg Oncol 9: 574–579PubMedCrossRefGoogle Scholar
  28. 28.
    Law WL, Choi HK, Lee YM, Chu KW (2004) Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes. Dis Colon Rectum 47: 39–43PubMedCrossRefGoogle Scholar
  29. 29.
    Dohmoto M, Hünerbein M, Schlag PM (1997) Application of rectal stents for palliation of obstructing rectosigmoid cancer. Surg Endosc 11: 758–761PubMedCrossRefGoogle Scholar
  30. 30.
    Baron TH (2004) Indications and results of endoscopic rectal stenting. J Gastroinest Surg 8: 266–269CrossRefGoogle Scholar
  31. 31.
    Brinkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL (1998) Acute colonic obstruction: clinical aspects and cost effectiveness of preoperative and palliative treatment with self-expanding metallic stents: a preliminary report. Radiology 206: 199–204Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • H. Ptok
    • 1
    • 2
  • F. Meyer
    • 2
  • F. Marusch
    • 1
  • R. Steinert
    • 2
  • I. Gastinger
    • 1
  • H. Lippert
    • 2
  • L. Meyer
    • 1
  1. 1.Department of SurgeryCarl-Thiem Hospital CottbusCottbusGermany
  2. 2.Department of General, Visceral and Vascular SurgeryOtto-von-Guericke University MagdeburgLeipziger Str. 44Germany

Personalised recommendations