Abstract
Purpose
Colorectal stents are being used for palliation and as a “bridge to surgery” in obstructing colorectal carcinoma. The purpose of this study was to review our experience with self-expanding metal stents (SEMS) as the initial interventional approach in the management of acute malignant large-bowel obstruction.
Methods
Between February 2002 and August 2009, 93 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum.
Results
In 66 patients, the stents were placed for palliation; whereas, in 27 patients they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 86) of the patients, with a clinical success rate of 86% (n = 80). Three perforations occurred during stent placement, two were treated by an emergency Hartmann operation, and one by a colostomy. In the intention to treat by stent, the peri-interventional mortality was 6.5% (6/93). Stent migration was reported in three cases (3%), and stent obstruction occurred in 11 cases (12%). Of the 24 patients with stents successfully placed as a bridge to surgery, 22 underwent elective single-stage operations with no death or anastomotic complication.
Conclusion
Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy.
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References
Cwikiel W, Stridbeck H, Tranberg KG, von Holstein CS, Hambraeus G, Lillo-Gil R, Willen R (1993) Malignant esophageal strictures: treatment with a self-expanding nitinol stent. Radiology 187:661–665
Irving JD, Adam A, Dick R, Dondelinger RF, Lunderquist A, Roche A (1989) Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology 172:231–326
Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499
Roubin GS, Cannon AD, Agrawal SK, Macander PJ, Dean LS, Baxley WA, Breland J (1992) Intracoronary stenting for acute and threatened closure complicating percutaneous transluminal coronary angioplasty. Circulation 85:916–927
Dohmoto M (1991) New method—endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 3:1507–1512
Watt AM, BmedSc, Faragher IG, FRACS, Griffin TT (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30
Khot UP, Lang AW, Murali K (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102
Repici A, Fregonese D, Costamagna G (2007) Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc 66:920–927
Meyer F, Marusch F, Coch A (2004) Emergency operation in carcinomas of the left colon: value of Hartmann's procedure. Tech Coloproctol 8:S226–S229
Desai DC, Brennan EJ, Reilly JF (1998) The utility of the Hartmann's procedure. Am J Surg 175:152–154
Zorcolo L, Covotta L, Carlomagno N (2003) Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 5:262–269
Biondo S, Pares D, Frago R (2004) Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 47:1889–1897
Hennekinne-Mucci S, Tuesch JJ, Bréhant O (2006) Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 21:538–541
Stoianov KH, Karashmalukov A, Iuliianov A (1998) An analysis of postoperative mortality in patients with large intestine occlusive ileus due to tumor origin. Khirurgiia 51:17–19
Deans GT, Krukowski ZH, Irvin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276
Park In Ja, Choi Gyu-Seog, Kang Byoung Mo (2009) Comparison of one-stage managements of obstructing left-sided colon and rectal cancer: stent-laparoscopic approach vs. intraoperative colonic lavage. J Gastrointest Surg 13:960–965
Hennekinne-Mucci S, Tuech JJ, Arnaud JP (2006) Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 21:538–541
De Salvo GL, Gava C, Pucciarelli S (2004) Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev 2:CD002101
Karadag A, Mentes BB, Uner A (2003) Impact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis 18:234–238
Tilney HS, Lovegrove RE, Purkayastha S (2006) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233
Vemulapalli R, Lara LF, Sreenarasimhaiah J (2009) A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. Dig Dis Sci 55(6):1732–1737
Shrivastava Vivek, Tariq Omar, Tiam ReeNee (2008) Palliation of Obstructing Malignant Colonic Lesions Using Self-Expanding Metal Stents: A Single-Center Experience. Cardiovasc Interv Radiol 31:931–936
Ripamonti C, Easson A, Gerdes H (2008) Management of malignant bowel obstruction. Eur J Cancer 44:1101–1115
Faragher IG, Chaitowitz IM, Stupart A (2008) Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis 10:668–672
Alcantara M, Serra X, Bombardó J (2007) Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years' experience. Tech Coloproctol 11:316–322
Kim Jin Soo, Hur Hyuk, Min Byung Soh (2009) Oncologic outcome of SEMS insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructive elective surgery. World J Surg 33:1281–1286
Sebastian S, Johnston S, Geoghegan T, Torregiani 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
Harris GJC, Senagore AJ, Lavery IC et al (2001) The management of neoplastic colorectal obstruction with colonic endoluminal stenting devises. Am J Surg 181:499–506
Breistein S, Rickenbacher A, Berdajs D, Puhan M, Clavien P-A, Demartines N (2007) Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 94:1451–1460
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Branger, F., Thibaudeau, E., Mucci-Hennekinne, S. et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis 25, 1481–1485 (2010). https://doi.org/10.1007/s00384-010-1003-9
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DOI: https://doi.org/10.1007/s00384-010-1003-9