Clinical outcomes of palliative self-expandable metal stent placement in right- and left-sided malignant colon obstruction: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study

Abstract

Self-expandable metal stent (SEMS) placement is commonly used for palliation of left-sided malignant colorectal obstruction (MCO). However, right-sided MCO is usually treated surgically. Recent studies that compared palliative SEMS insertion and emergency surgery in right-sided MCOs have reported conflicting results. This study aimed to compare the effectiveness of palliative SEMS placement in left-sided MCOs and right-sided MCOs and to investigate the predictive factors for clinical success and risk factors for complications. Data from 469 patients who underwent palliative SEMS placement for MCO at 6 hospitals in the Honam province of South Korea between 2009 and 2018 were reviewed. Among them, 69 patients with right-sided MCO and 400 patients with left-sided MCO who underwent SEMS placement for palliative purposes were enrolled. Clinical success, overall survival, complications, and predictive factors for clinical success and risk factors for complications were included as the main outcome measures. The clinical success rates were 97.1% (65/67) in right-sided MCO patients and 88.2% (353/400) in left-sided MCO patients. Complications including stent migration, tumor ingrowth, outgrowth, perforation, bacteremia/fever, and bleeding occurred in 10.1% (7/69) of right-sided MCO patients and 19.9% (79/400) of left-sided MCO patients. The mean overall survival of right-sided MCO was 28.02 months and 18.23 months for left-sided MCO. In multivariate logistic regression analysis, T3 stage tumors and the use of uncovered stents were significant factors for the clinical success of SEMS. The use of covered stents and performance status score of 0 to 2 were independent significant risk factors for complications. Palliative SEMS placement in right-sided MCO showed better clinical success rates than left-sided MCO. The use of uncovered stents is recommended for higher clinical success rates and lower complication rates.

Spiliotis-Farfarelos Maneuver for the Management of Small Bowel Obstruction and Frozen Pelvis in Patients With Peritoneal Metastasis

“…Malignant bowel obstruction is associated with poor prognosis also indicating disease progression [5]. The management of those patients seems extremely challenging especially due to the emergent nature of the procedure that is associated with increased morbidity and mortality compared to elective operations [13].…”

“…The decision to proceed with the operation is difficult and should be based on the patient's performance status and the symptoms caused by the obstruction [5,13]. Furthermore, an estimation of the patient's life expectancy is also of paramount significance [5].…”

“…Malignant bowel obstruction is associated with poor prognosis also indicating disease progression [ 5 ]. The management of those patients seems extremely challenging especially due to the emergent nature of the procedure that is associated with increased morbidity and mortality compared to elective operations [ 13 ]. The decision to proceed with the operation is difficult and should be based on the patient’s performance status and the symptoms caused by the obstruction [ 5 , 13 ].…”

“…The management of those patients seems extremely challenging especially due to the emergent nature of the procedure that is associated with increased morbidity and mortality compared to elective operations [ 13 ]. The decision to proceed with the operation is difficult and should be based on the patient’s performance status and the symptoms caused by the obstruction [ 5 , 13 ]. Furthermore, an estimation of the patient’s life expectancy is also of paramount significance [ 5 ].…”

Transanal ileus catheter combined with nasal ileus catheter in the treatment of malignant ileus in 14 cases: a case series and literature review

“…This treatment group of preoperative decompression is more patients with early malignant intestinal obstruction. Oh et al reported that palliative self-expandable metal stent in the treatment of right malignant intestinal obstruction has a higher success rate and lower complications than the left side (17). The related stent therapy is also limited to single stenosis lesions and cannot be applied to patients with multiple abdominal metastases or extensive dissemination of tumor foci in the abdominal cavity.…”