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Stenting of the Colon in Patients with Malignant Large Bowel Obstruction: a Local Experience

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Abstract

Purpose

There is an increasing evidence base to support the use of self-expanding metallic gastrointestinal stents. In patients with colorectal cancer, they are used as a bridge to surgery and for palliation. The purposes of this study are to assess technical success, clinical outcome, complication rate and patency following colonic stent insertion in patients with colonic cancer at a local level and to compare our results with the current evidence base.

Methods

A retrospective, two-centre study was conducted. Twenty-seven patients were included over a 5-year period. Six patients had undergone stent insertion as a bridge to surgery, and 21 had the procedure for palliation.

Results

Initial technical success was achieved in 26 of 27 patients (96%). Of these 26 patients, clinical success was achieved in 24 patients (92%). Five patients (21%) suffered from stent re-occlusion, and one patient (4%) suffered from stent migration. There was one case (4%) of procedure-related perforation. Of the 19 palliative patients in whom clinical success was achieved, 17 (89%) were alive at 30 days, 13 (68%) at 90 (53%) days and 10 at 180 days. Average stent patency was 195 days.

Conclusion

WallFlex® self-expanding metallic gastrointestinal stents are a safe and effective means of alleviating obstructive symptoms in patients with colonic cancer requiring palliative treatment or as a bridge to surgery. Our data suggest that although a small percentage of patients are affected by stent re-occlusion, this does not contribute to premature mortality. They improve quality of life in palliative care patients as well as reducing premature morbidity and mortality caused by emergency surgery.

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References

  1. Waldron RP, Donovan IA, Drumm J, Motrram SN, Tedman S. Emergency presentation and mortality from colorectal cancer in the elderly. Br J Surg. 1986;73:214–6.

    Article  PubMed  CAS  Google Scholar 

  2. Kyllonen L. Obstruction and perforation complicating colorectal carcinoma. Acta Chir Scand. 1987;153:607–14.

    PubMed  CAS  Google Scholar 

  3. Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol. 2006;101:1098–103.

    Article  PubMed  Google Scholar 

  4. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma. Dis Colon Rectum. 2003;46:24–30.

    Article  PubMed  Google Scholar 

  5. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.

    Article  PubMed  CAS  Google Scholar 

  6. Bethge N, Sommer A, Vakil N. Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents. Am J Gastroenterol. 1998;93:1829–32.

    Article  PubMed  CAS  Google Scholar 

  7. Cheng YS, Li MH, Chen WX, Zhuang QX, Chen NW, Shang KZ. Follow-up evaluation for benign stricture of upper gastrointestinal tract with stent insertion. World J Gastroenterol. 2003;9:2609–11.

    PubMed  Google Scholar 

  8. Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig. 1991;3:1507–12.

    Google Scholar 

  9. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81:1270–6.

    Article  PubMed  CAS  Google Scholar 

  10. Serpell JW, McDermott FT, Katrivessis H, Hughes ES. Obstructing carcinomas of the colon. Br J Surg. 1989;76:965–9.

    Article  PubMed  CAS  Google Scholar 

  11. Yu BM. Surgical treatment of acute intestinal obstruction caused by large bowel carcinoma (in Chinese). Zhonghua Wai Ke Za Zhi. 1989;27:285–615.

    PubMed  CAS  Google Scholar 

  12. Umpleby HC, Williamson RC. Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum. 1984;27:299–304.

    Article  PubMed  CAS  Google Scholar 

  13. Biondo S, Pares D, Fragno R, Marti-Rague J, Kreisler E, et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum. 2004;47:1889–97.

    Article  PubMed  Google Scholar 

  14. Fegiz G, Ramacciato G, D’Angelo F, et al. Management and survival of patients affected with obstructive colorectal cancer. Int Surg. 1992;77:251–5.

    PubMed  Google Scholar 

  15. Porter JA, Salvati EP, Rubin RJ, et al. Complications of colostomies. Dis Colon Rectum. 1989;32:299–303.

    Article  PubMed  CAS  Google Scholar 

  16. Pearce NW, Scott SD, Karran JT. Timing and method of reversal of Hartmann’s procedure. Br J Surg. 1992;79:839–41.

    Article  PubMed  CAS  Google Scholar 

  17. Olubaniyi BO, McFaul CD, Yip VSK, Abbott G, Johnson M. Stenting for large bowel obstruction—evolution of a service in a district general hospital. Ann R Coll Surg Engl. 2009;91(1):55–8.

    Article  PubMed  CAS  Google Scholar 

  18. Kim H, Kim SH, Choi SY, Lee KH, Won JY, Leedo Y, et al. Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts in the treatment of acute malignant colorectal obstruction. J Vasc Interv Radiol. 2008;19(12):1709–16.

    Article  PubMed  Google Scholar 

  19. Baerlocher MO, Asch MR, Vellahottam A, Puri G, Andrews K, Myers A. Safety and efficacy of gastrointestinal stents in cancer patients at a community hospital. Can J Surg. 2008;51(2):130–4.

    PubMed  Google Scholar 

  20. Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl. 2008;90(3):181–6.

    Article  PubMed  Google Scholar 

  21. Khot U, Wenk Lang A, Murali H, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002;89:1096–102.

    Article  PubMed  CAS  Google Scholar 

  22. Sebastian S, Johnston S, Geoghegan T. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–7.

    Article  PubMed  Google Scholar 

  23. Dionigi G, Villa F, Rovera F, Boni L, Carrafiello G, Annoni M, et al. Colonic stenting for malignant disease: review of literature. Surg Oncol. 2007;16 Suppl 1:S153–5.

    Article  PubMed  Google Scholar 

  24. Meisner S, Hensler M, Knop FK. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single centre. Dis Colon Rectum. 2004;47:444–50.

    Article  PubMed  Google Scholar 

  25. Soto S, Lopez-Roses L, Gonzalez-Ramirez A. Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents: experience in a community hospital. Surg Endosc. 2006;20:1072–6.

    Article  PubMed  CAS  Google Scholar 

  26. Athreya S, Moss J, Urquhart G. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome 5 year review. Eur J Radiol. 2006;60:91–4.

    Article  PubMed  CAS  Google Scholar 

  27. Pommergaard HC, Vilmann P, Jakobsen HL, Achiam MP. A clinical evaluation of endoscopically placed self-expanding metallic stents in patients with acute large bowel obstruction. Scand J Surg. 2009;98:143–7.

    PubMed  CAS  Google Scholar 

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Acknowledgements

We thank Ms. A. Fitzgerald-Smith for stenting data from St. Helen’s and Knowsley Teaching Hospitals, Dr. P. O’Toole for stenting data from Aintree University Hospital NHS Foundation Trust and Dr. J. Browne for data analysis.

Disclosure

The authors have no disclosures to make. No funding was received.

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Authors and Affiliations

  1. Department of General Surgery, St. Helens and Knowsley Teaching Hospitals, Whiston Hospital NHS Trust, Warrington Rd, Whiston, Prescot, L35 5DR, UK

    Malcolm West & Robert Kiff

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  1. Malcolm West
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  2. Robert Kiff
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Correspondence to Malcolm West.

Additional information

This paper is based on a previous communication to a society. Oral presentation at the international congress of the Association of Surgeons of Great Britain and Ireland, Glasgow 2009.

Synopsis

There is an increasing evidence base to support the use of self-expanding metallic gastrointestinal stents. They are a safe and effective means of alleviating obstructive symptoms in patients with colonic cancer and improve quality of life for palliative care patients.

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West, M., Kiff, R. Stenting of the Colon in Patients with Malignant Large Bowel Obstruction: a Local Experience. J Gastrointest Canc 42, 155–159 (2011). https://doi.org/10.1007/s12029-010-9178-4

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  • DOI: https://doi.org/10.1007/s12029-010-9178-4

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