Bowel function following insertion of self‐expanding metallic stents for palliation of colorectal cancer

Rjo., Davies; D'Sa, I. Barros; Lucarotti, M. E.; Fowler, A L.; Tottle, A.; Birch, P. A.; Cook, TA

doi:10.1111/j.1463-1318.2005.00765.x

Cited by 28 publications

(13 citation statements)

References 11 publications

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“…9,10,17,20 The episode of constipation that occurred approximately 3 months after stent placement may be attributable to the elimination of lactulose from the dog’s treatment regimen in an effort to control the diarrhea. In a clinical report 1 of colonic stenting in 2 cats that survived nearly 7 months after stent placement, the cats continued to receive oral administration of lactulose and a low-residue diet g to maintain soft feces.…”

Section: Discussionmentioning

confidence: 99%

Use of a nitinol stent to palliate a colorectal neoplastic obstruction in a dog

Culp

MacPhail

Perry

et al. 2011

javma

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Case Description A 12-year-old castrated male Labrador Retriever was evaluated for clinical signs associated with colorectal obstruction. Clinical Findings The dog had a 2-week history of tenesmus and hematochezia. On rectal examination, an annular colorectal mass was palpable extending orad into the pelvic canal. The original diagnosis of the colorectal mass was a mucosal adenoma. The dog was maintained on a low-residue diet and fecal softeners for a period of 13 months after initial diagnosis. At that time, medical management was no longer effective. Treatment and Outcome Placement of a colonic stent was chosen to palliate the clinical signs associated with colorectal obstruction. By use of fluoroscopic and colonoscopic guidance, a nitinol stent was placed intraluminally to open the obstructed region. Placement of the stent resulted in improvement of clinical signs, although tenesmus and obstipation occurred periodically after stent placement. At 212 days after stent placement, the patient had extensive improvement in clinical signs with minimal complications; however, clinical signs became severe at 238 days after stent placement, and the dog was euthanized. Histologic evaluation of the rectal tumor from samples obtained during necropsy revealed that the tumor had undergone malignant transformation to a carcinoma in situ. Clinical Relevance A stent was successfully placed in the colon and rectum to relieve obstruction associated with a tumor originally diagnosed as a benign neoplasm. Placement of colorectal stents may be an option for the palliation of colorectal obstruction secondary to neoplastic disease; however, clinical signs may persist, and continuation of medical management may be necessary.

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Section: Discussionmentioning

confidence: 99%

Use of a nitinol stent to palliate a colorectal neoplastic obstruction in a dog

Culp

MacPhail

Perry

et al. 2011

javma

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“…Advantages include technical and clinical success rates exceeding 90%, 5 stentrelated mortality of less than 1% 5 and possibly improved quality of life compared with palliative surgery. 6,7 The potential complications of SEMS placement include stent migration, reobstruction and, the most worrisome, colonic perforation. The incidence of the latter approaches 4% 5 and is a serious concern for clinicians because mortality after emergency surgery for a perforated CRC has been found to be approximately 20%-30% in recent studies.…”

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confidence: 99%

Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

et al. 2015

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Background: Self-expanding metal stents (SEMS) are increasingly used in the treatment of malignant large bowel obstruction in the setting of inoperable colorectal cancer. Perforation is a well-known complication associated with these devices. The addition of the vascular endothelial growth factor inhibitor bevacizumab is suspected to increase the rate, but the extent of the increase is not known. Methods:We retrospectively reviewed the records of patients receiving SEMS in tertiary hospitals in Calgary, Alta., between October 2001 and January 2012. Results:We reviewed the records of 87 patients with inoperable colorectal cancer who received SEMS during our study period. Nine perforations occurred in total: 4 of 30 (13%) patients who received no chemotherapy, 3 of 47 (6%) who received chemotherapy but no bevacizumab, and 2 of 10 (20%) who received chemotherapy and bevacizumab. These two patients received bevacizumab with FOLFIRI after SEMS placement, and they had peritoneal disease. Conclusion:Our case series and other studies suggest that bevacizumab may increase the risk of colonic perforation in the setting of SEMS. Caution should be used when combining these therapies.

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“…Overall, stenting appears to be successful in most patients and is associated with low morbidity. Poor bowel function, pain, and incomplete relief of symptoms after stent placement have been reported in other series and require defi nitive surgery for resolution [24]. The overall survival of patients does not appear to be adversely affected by the use of colonic stents [25].…”

Section: Alternative Treatmentsmentioning

confidence: 97%

Surgical management of malignant bowel obstruction: Strategies toward palliation of patients with advanced cancer

Debernardo

2009

Curr Oncol Rep

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The management of malignant bowel obstruction is a challenging problem because of the poor definition of malignant bowel obstruction compounded by its myriad clinical presentations. Surgeons are called upon to perform invasive procedures designed to alleviate symptoms or correct the underlying obstruction. Unfortunately, interventions may carry a high rate of morbidity and mortality. Balancing these risks and potential benefits is complicated, and there is a paucity of data to help guide these difficult decisions. The surgeon is further handicapped when he or she is not understanding of the patient's disease status, prognosis, or long-term goals. Diligent discussion with the primary team and frank discussions with the patient and his or her family are essential to formulate an appropriate plan. It is also essential that the surgeon have a thorough understanding of the surgical options to relieve or palliate malignant bowel obstruction as well as effective nonsurgical interventions. The best approach may be appropriate surgical intervention coupled with aggressive medical management.

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Bowel function following insertion of self‐expanding metallic stents for palliation of colorectal cancer

Cited by 28 publications

References 11 publications

Use of a nitinol stent to palliate a colorectal neoplastic obstruction in a dog

Use of a nitinol stent to palliate a colorectal neoplastic obstruction in a dog

Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

Surgical management of malignant bowel obstruction: Strategies toward palliation of patients with advanced cancer

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