Skip to main content

Advertisement

SpringerLink
Log in

Stenting for malignant colorectal obstruction: a single-center experience with 101 patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Self-expanding metal stents (SEMS) are used for colorectal obstruction preoperatively and palliatively. Limited data on the use of stents for obstruction caused by extracolonic malignancies exist, and the results are unclear. Our goal was to evaluate the efficacy and safety of SEMS for patients stented as a bridge to surgery and as palliation for colorectal cancer or extracolonic malignancies.

Methods

Between 1998 and 2009, a total of 101 patients underwent 108 stenting procedures for malignant colorectal obstruction. The results were studied retrospectively.

Results

Of the study cohort, 11 patients were stented as a bridge to surgery. For palliatively stented patients, the etiology of obstruction was colorectal cancer in 66 patients and extracolonic malignancy in 24. Overall technical success was 99% and clinical success 88%. Complications occurred for 20 (20%) patients in 22 of 108 procedures. Complications included perforation (n = 6), recurrent obstruction (n = 8), and stent migration (n = 4). A median time to complication was 81.5 days. The overall stent placement-related mortality was 2/101 (2%). For patients stented as a bridge to surgery, a primary anastomosis in elective operations was achieved for 90% (9/10). In the palliation groups, patients with colorectal cancer had significantly higher clinical success rates than patients with extracolonic malignancies (94% vs. 65%, P = 0.0005). There was no difference in complications, operation, and stoma rates between the palliation groups.

Conclusions

SEMS is a safe and effective treatment for patients stented as a bridge to surgery or as palliation due to colorectal cancer. Stents are also useful in relieving obstruction due to extracolonic malignancies, but the clinical failure rate is higher than for colorectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Leitman IM, Sullivan JD, Brams D, DeCosse JJ (1992) Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 174:513–518

    PubMed  CAS  Google Scholar 

  2. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C (1998) Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 85:1260–1265

    Article  PubMed  CAS  Google Scholar 

  3. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD, Association of coloproctology of Great Britain, Ireland (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81

    Article  PubMed  Google Scholar 

  4. Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    Article  PubMed  CAS  Google Scholar 

  5. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057

    Article  PubMed  Google Scholar 

  6. Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30

    Article  PubMed  Google Scholar 

  7. 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 45:401–406

    Article  PubMed  Google Scholar 

  8. Brehant O, Fuks D, Bartoli E, Yzet T, Verhaeghe P, Regimbeau JM (2009) Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Colorectal Dis 11:178–183

    Article  PubMed  CAS  Google Scholar 

  9. Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I (2006) Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery? World J Surg 30:1481–1487

    Article  PubMed  Google Scholar 

  10. Faragher IG, Chaitowitz IM, Stupart DA (2008) Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis 10:668–672

    Article  PubMed  CAS  Google Scholar 

  11. Vemulapalli R, Lara LF, Sreenarasimhaiah J, Harford WV, Siddiqui AA (2010) A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. Dig Dis Sci 55:1732–1737

    Article  PubMed  Google Scholar 

  12. Bedirli A, Mentes BB, Onan A, Kerem M, Pala MI, Sakrak O, Oguz M (2005) Colorectal intervention as part of surgery for patients with gynaecological malignancy. Colorectal Dis 7:228–231

    Article  PubMed  CAS  Google Scholar 

  13. Miyayama S, Matsui O, Kifune K, Yamashiro M, Yamamoto T, Kitagawa K, Kasahara Y, Asada Y, Iida Y, Miura S (2000) Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent. AJR Am J Roentgenol 175:1631–1637

    PubMed  CAS  Google Scholar 

  14. Pothuri B, Guirguis A, Gerdes H, Barakat RR, Chi DS (2004) The use of colorectal stents for palliation of large-bowel obstruction due to recurrent gynecologic cancer. Gynecol Oncol 95:513–517

    Article  PubMed  Google Scholar 

  15. Caceres A, Zhou Q, Iasonos A, Gerdes H, Chi DS, Barakat RR (2008) Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series. Gynecol Oncol 108:482–485

    Article  PubMed  Google Scholar 

  16. Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, Kim WH (2008) Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum 51:578–583

    Article  PubMed  Google Scholar 

  17. Trompetas V, Saunders M, Gossage J, Anderson H (2010) Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies. Int J Colorectal Dis 25:851–854

    Article  PubMed  Google Scholar 

  18. Keswani RN, Azar RR, Edmundowicz SA, Zhang Q, Ammar T, Banerjee B, Early DS, Jonnalagadda SS (2009) Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy. Gastrointest Endosc 69:675–680

    Article  PubMed  Google Scholar 

  19. Suh JP, Kim SW, Cho YK, Park JM, Lee IS, Choi MG, Chung IS, Kim HJ, Kang WK, Oh ST (2010) Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc 24:400–406

    Article  PubMed  Google Scholar 

  20. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  21. Keranen I, Lepisto A, Udd M, Halttunen J, Kylanpaa L (2010) Outcome of patients after endoluminal stent placement for benign colorectal obstruction. Scand J Gastroenterol 45:725–731

    Article  PubMed  Google Scholar 

  22. Alcantara M, Serra X, Bombardo J, Falco J, Perandreu J, Ayguavives I, Mora L, Hernando R, Navarro S (2007) Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol 11:316–322

    Article  PubMed  CAS  Google Scholar 

  23. Foo C, Poon JT, Law WL (2011) Self-expanding metallic stents for acute left-sided large bowel obstruction: a review of 130 patients. Colorectal Dis 13(5):549–554

    Article  PubMed  CAS  Google Scholar 

  24. Tan WS, Tang CL, Shi L, Eu KW (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96:462–472

    Article  PubMed  CAS  Google Scholar 

Download references

 

Disclosure

Drs. I. Keränen, A. Lepistö, M. Udd, J. Halttunen, and L. Kylänpää have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Finland

    Ilona Keränen, Anna Lepistö, Marianne Udd, Jorma Halttunen & Leena Kylänpää

Authors
  1. Ilona Keränen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Lepistö
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marianne Udd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jorma Halttunen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leena Kylänpää
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilona Keränen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keränen, I., Lepistö, A., Udd, M. et al. Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc 26, 423–430 (2012). https://doi.org/10.1007/s00464-011-1890-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1890-z

Keywords

Search

Navigation