Palliative stent implantation in the treatment of malignant colorectal obstruction
- 130 Downloads
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.
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.
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.
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.
KeywordsColonic obstruction Irresectable colorectal carcinoma Metastasized colorectal carcinoma Palliative surgical interventions Self-expanding metal stent SEMS
- 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
- 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
- 16.Dohmoto M (1991) New method: endoscopic implantation of rectal stent in palliation of malignant stenosis. Endoscopia Digestiva 35: 912–913Google Scholar
- 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
- 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