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Self-expandable Metallic Stents in Patients with Stage IV Obstructing Colorectal Cancer

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Abstract

Background

The aim of the present study was to analyze the results of our experience with elective placement of self-expandable metallic stents (SEMS) in patients with stage IV obstructing colorectal cancer. A systematic review of the literature was also carried out to analyze the factors influencing the results of SEMS placement and to determine if there has been any improvement in the more recent period.

Materials and methods

The results of a personal series of 100 patients were analyzed. There was no case of mortality or major morbidity. The systematic review included 27 articles published from April 2007 to December 2011.

Results

In our experience the technical success rate was 96 % and the clinical success rate was 92 %. During the follow-up period a repeat colonoscopy was needed in 31 % of the patients for recurrent symptoms of obstruction due to fecal impaction (19 %), tumor growth (8 %), or stent dislodgment (4 %). Review of the literature showed similar results, with a significant improvement in the reports of the last 6 years; procedures performed on an emergency basis had poorer results.

Conclusions

Self-expandable metallic stent placement offers a valid alternative to surgery in patients with obstructing stage IV colorectal cancer, but careful follow-up is required.

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References

  1. Dohmoto M (1991) New method; endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Digest 3:1507–1512

    Google Scholar 

  2. Tejero E, Mainar A, Fernandez L et al (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37:1558–1559

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Nagula S, Ishill N, Nash C et al (2010) Quality of life and symptoms control after stent placement or surgical palliation of malignant colorectal obstructions. J Am Coll Surg 210:45–53

    Article  PubMed  Google Scholar 

  5. Baron TH (2010) Colonic stenting: a palliative measure only or a bridge to surgery? Endoscopy 42:163–168

    Article  PubMed  CAS  Google Scholar 

  6. Lee JH, Ross WA, Davila R (2010) Self-expandable metal stents (SEMS) can serve as a bridge to surgery or as a definitive therapy in patients with an advanced stage of cancer: clinical experience of a tertiary cancer center. Dig Dis Sci 55:3530–3536

    Article  PubMed  CAS  Google Scholar 

  7. Park JK, Lee MS, Ko BM et al (2011) Outcome of palliative self-expanding metal stent placement in malignant colorectal obstruction according to the stent type and manufacturer. Surg Endosc 25:1293–1299

    Article  PubMed  Google Scholar 

  8. Manes G, de Bellis M, Fuccio L et al (2011) Endoscopic palliation in patients with incurabile malignant obstruction by means of self-expanding metal stents; analysis of results and predictors of outcomes in a large multicenter series. Arch Surg 146:1157–1162

    Article  PubMed  Google Scholar 

  9. Van Hooft JE, Bemelman WA, Oldenburg B et al (2011) Colonic stenting versus emergency surgery for acute left sided malignant colonic obstruction: a multicentre randomized trial. Lancet Oncol 12:344–352

    Article  PubMed  Google Scholar 

  10. Bielawska B, Hookey LC, Jalink D (2010) Large-diameter self expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy. Surg Endosc 24:2814–2821

    Article  PubMed  Google Scholar 

  11. Fiori E, Lamazza A, Schillaci A et al (2012) Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. Am J Surg 204:321–326

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Lee HJ, Hong SP, Cheon JH et al (2011) Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers; endoscopic stenting versus surgery. Gastrointest Endosc 73:535–542

    Article  PubMed  Google Scholar 

  14. Song HY, Kim JH, Shin JH et al (2007) A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 39:448–454

    Article  PubMed  Google Scholar 

  15. 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 

  16. Fregonese D, Naspetti R, Ferrer S et al (2008) Ultraflex precision colonic stent placement as a bridge to surgery in patients with colonic malignant obstruction. Gastrointest Endosc 67:68–73

    Article  PubMed  Google Scholar 

  17. Alcantara M, Serra X, Bombardò J (2007) Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 year experience. Tech Coloproctol 11:316–322

    Article  PubMed  CAS  Google Scholar 

  18. Shrivastava V, Tariq O, Tiam R et al (2008) Palliation of obstructing malignant colonic lesions using self expanding metal stents: a single-center experience. Cardiovasc Interv Radiol 31:931–936

    Article  Google Scholar 

  19. Im JP, Kim SG, Kang HW et al (2008) Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorect Dis 23:789–794

    Article  Google Scholar 

  20. Kim H, Kim SH, Choi SY et al (2008) Fluoroscopically guided placement of self expandable metallic stents and stent grafts in the treatment of malignant colorectal obstruction. J Vasc Interv Radiol 19:1709–1716

    Article  PubMed  Google Scholar 

  21. Keswani RN, Azar RR, Edmundowicz SA et al (2009) Stenting for malignant colonic obstruction: a comparison of efficacy and complications for colonic versus extracolonic malignancy. Gastrointest Endosc 69:675–680

    Article  PubMed  Google Scholar 

  22. Jung MK, Park SY, Jeon SW et al (2010) Factors associated with the long term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction. Surg Endosc 24:525–530

    Article  PubMed  Google Scholar 

  23. Vemulapalli R, Lara LF, Sreenarasinhaiah 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 

  24. Al Samaaree A, Fasih T, Hayat M (2010) Use of self-expandable stent for obstructive distal and proximal large bowel: a retrospective study in a single center. J Gastrointest Cancer 41:43–46

    Article  Google Scholar 

  25. Small AJ, Coelho-Prabhu N, Baron TH (2010) Endoscopic placement of self expandable metal stents for malignant colonic obstruction: long-term outcome and complication factors. Gastrointest Endosc 71:560–572

    Article  PubMed  Google Scholar 

  26. Donnellan F, Cullen G, Cagney D (2010) Efficacy and safety of colonic stenting for malignant diseasse in the elderly. Int J Colorectal Dis 25:747–750

    Article  PubMed  Google Scholar 

  27. Branger F, Thibadeau E, Mucci-Hennekinne S et al (2010) Management of acute malignant large-bowel obstruction with self-expanding metal stents. Int J Colorectal Dis 25:1481–1485

    Article  PubMed  Google Scholar 

  28. Luigiano C, Ferrara F, Fabbri C et al (2011) Through-the-scope large-diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single centre experience with long term follow-up. Scand J Gastroenterol 46:591–596

    Article  PubMed  Google Scholar 

  29. Arya N, Blair N, Arya P (2011) Community experience of colonic stenting in patients with acute large bowel obstruction. Can J Surg 54:282–285

    Article  PubMed  Google Scholar 

  30. DeGregorio MA, Laborda A, Tejero E et al (2011) Ten year retrospective study of treatment of malignant colonic obstructions with self expandable stents. J Vasc Intrervent Radiol 22:870–878

    Article  Google Scholar 

  31. Saida Y, Enomoto T, Takabayashi K et al (2011) Outcome of 141 patients of self-expandable metallic stent placements for malignant and benign colorectal strictures in a single center. Surg Endosc 25:1748–1752

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department Pietro Valdoni-Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy

    Antonietta Lamazza, Enrico Fiori, Alberto Schillaci, Ercole DeMasi, Stefano Pontone & Antonio V. Sterpetti

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  1. Antonietta Lamazza
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  2. Enrico Fiori
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  3. Alberto Schillaci
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  4. Ercole DeMasi
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  5. Stefano Pontone
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  6. Antonio V. Sterpetti
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Correspondence to Antonietta Lamazza or Antonio V. Sterpetti.

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Lamazza, A., Fiori, E., Schillaci, A. et al. Self-expandable Metallic Stents in Patients with Stage IV Obstructing Colorectal Cancer. World J Surg 36, 2931–2936 (2012). https://doi.org/10.1007/s00268-012-1767-x

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