Abstract
Background
Since their introduction, selfextending metal stents (SEMS) have established themselves as an option in the treatment of obstructive colorectal cancer. Thanks to stenting, patients traditionally treated with emergency surgery can now be converted to scheduled surgery with mechanical preparation of the colon and primary anastomosis. Stenting represents a valid one-step surgical alternative for intestinal obstruction of the colon.
Methods
We performed a prospective study of 95 patients (mean age, 68 years; range 48–94) with large bowel obstruction due to colorectal cancer treated with SEMS placed under fluoroscopic guidance, some as a bridge to surgery (group A) and others with palliative intent (group B). Computed tomography was performed for diagnostic purposes and to study the extent of disease.
Results
Treatment was palliative in 28 cases (group B) and as a bridge to surgery in 67 (group A). The latter group underwent mechanical preparation of the colon and elective surgery. No patients died as a result of the procedure. In 90 cases (95%), treatment was effective and the obstruction resolved. Complications were 4 cases of perforation, 1 of tenesmus, 4 obstructions and 4 migrations. In 7 cases, a second stent was inserted to allow subsequent scheduled surgery.
Conclusions
Self-extending stents resolve colorectal cancer obstruction and allow optimal patient staging and scheduled surgical treatment. Stenting is also a useful option in advanced or irresectable tumors, avoiding the need for surgery and offering good palliation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Boyle P (1998) Some recent developments in the epidemiology of colorectal cancer. In: Bleiberg H, Rougier P, Wilke HJ (eds) Management of colorectal cancer. Martin Dunitz, London, pp 19–34
Wingo PA, Cardinez CJ, Landis SH et al (2003) Long-term trends in cancer mortality in the United States. Cancer 97[12 Suppl]:3133–3275
Deans GT, Krukowski ZH, Irwin T (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276
Rield S, Wiebelt H, Bergmann U, Hermanek P Jr (1995) Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg 66:597–606
Serpell JW, McDermott FT, Katrivessis H, Hughes ESR (1989) Obstructing carcinomas of the colon. Br J Surg 76:965–969
Korenaga D, Baba H, Kakeji Y et al (1991) Prognostic factors in Japanese patients with colorectal cancer: the significance of large bowel obstruction univariate and multivariate analyses. J Surg Oncol 47:188–192
Runkel NS, Schlag P, Scharz V et al (1991) Outcome after emergency surgery of the large intestine. Br J Surg 78:183–188
Umpleby HC, Williamson RC (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304
Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79:706–709
Leitman IM, Sullivan JD, Brams D et al (1992) Multivariate analysis of the morbidity and mortality from initial surgical management of obstructing carcinoma of the colon. Surg Gynaecol Obstet 174:513–518
Mulcahy HE, Skelly MM, Hussain A et al (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:707–710
Riedl S, Wiebelt H, Bergmann U, Hermanek PJ (1995) Postoperative Komplikationen und Letalität der chirurgischen operativen Therapie des Coloncarcinoms. Chirurg 66:597–606
Tobaruela E, Camunas J, Enriquez-Navascues JM et al (1997) Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 89:13–22
Stoianov KH, Karashmalukov A, Iuliianov A, Rachkov I, Vulchev D (1998) An analysis of postoperative mortality in patients with large intestine occlusive ileus due to tumor origin. Khirurgiia (Sofiia) 51:17–19
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
Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth Ch (1998) Improved outcome after emergency for cancer of the large intestine. Br J Surg 85:1260–1265
Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD (2002) The ACPGBI Colorectal Cancer Study 2002. Part A: unadjusted outcomes. Association of Coloproctology of Great Britain and Ireland, London
Poon JT, Chan B, Law WL (2005) Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 48(3):493–498
Bromage SJ, Cunliffe WJ (2007) Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center. Dis Colon Rectum 50(2):192–196
Law WL, Choi HK, Lee YM, Chu KW (2004) Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes. Dis Colon Rectum 47:39–43
Paul DL, Pinto Pabon I, Fernandez Lobato R, Montes LC (1999) Palliative treatment of malignant colorectal strictures with metallic stents. Cardiovasc Intervent Radiol 22:29–36
Rey JF, Romanczyk T, Greff M (1995) Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients. Endoscopy 27:501–504
Itabashi M, Hamano K, Kameoka S, Asahina K (1993) Selfexpanding stainless steel stent application in rectosigmoid stricture. Dis Colon Rectum 36:508–511
Tejero E, Mainar A, Fernández L, Tobio R, De Gregorio MA (1995) New procedure for relief of malignant obstruction of the left colon. Br J Surg 82:34–35
Tejero E, Fernández L, Mainar A et al (1997) Initial results of a new procedure for the treatment of malignant obstruction of the left colon. Dis Colon Rectum 40:432–436
Suzuki N, Saunders B, Thomas-Gibson S, Akle Ch, Marshall M, Halligan S (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 47:1201–1207
Khot UP, Wenk Lang A, Murali K, Parker MC (2002) Systematic review of the efficacy and safely of colorectal stents. Br J Surg 89:1096–1102
Sebastian S, Johnston S, Geoghegan T, Torregiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of selfexpanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057
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(1):24–30
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
Mucci-Hennekinne S, Kervegant AG, Regenet N et al (2007) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surg Endosc 21(7):1101–1103
Small AJ, Young-Fadok TM, Baron TH (2007) Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc Aug 18. Epub ahead of print
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229
Law WL, Choi HK, Lee YM, Chu KW (2004) Laparoscopic colectomy for obstructing sigmoid cancer with prior insertion of an expandable metallic stent. Surg Laparosc Endosc Percutan Tech 14:29–32
Balague C, Targarona EM, Sainz S et al (2004) Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Preliminary results. Dig Surg 21:282–286
Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T et al (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstruction? Results of a study and cost-effectiveness analysis. Surg Endosc 18:421–426
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
Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative bridge to surgery expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46[Suppl]:S44–S49
Parker MC (2006) Colorectal stenting. Br J Surg 93:907–908
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alcantara, M., Serra, X., Bombardó, J. et al. Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol 11, 316–322 (2007). https://doi.org/10.1007/s10151-007-0372-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-007-0372-8