Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Abstract

OBJECTIVES:To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS:This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS:A total of 182 patients were enrolled with obstructive tumor in the left colon (85 % ), rectum (11 % ), or splenic fl exure (4 % ). Of these patients, 86 % had localized colorectal cancer without metastasis. Procedural success was 98 % (177 / 181). Clinical success was 94 % (141 / 150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8 % (13 / 167), including perforation in 3 % (5 / 167), stent migration in 1.2 % (2 / 167), bleeding in 0.6 % (1 / 167), persistent colonic obstruction in 1.8 % (3 / 167), and stent occlusion due to fecal impaction in 1.2 % (2 / 167). One patient died from complications related to surgical management of a perforation.CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

Colorectal Emergencies: Review and Controversies in the Management of Large Bowel Obstruction

“…In a paper by Vitale et al, up to 10 % of the patients in their review had a synchronous cancer, and as a result of being able to have preoperative stenting, they were able to have a full evaluation and make a more educated surgical resection plan. [28][29][30][31][32][33] In addition, a costeffectiveness analysis concluded that colonic stent insertion followed by surgery was more effective and less costly than emergency surgery, especially when looking at the patient's quality of life. 25 A multi center study showed that colonic stenting relieved the obstruction in 93 % of patients, and as a result, 92 % of patients were able to undergo a single-stage resection and anastomosis within 8.6 days of stent placement, with only one patient having a perforation.…”

Colorectal stenting as first-line treatment in acute colonic obstruction

“…In this setting, colonic stents represent the best option when skills are available [7] . [18] 2008 51 51 (100) 43 (84.3) 1 (1.9) Fernández-Esparrach et al [19] 2010 47 44 (94) 44 (94) 3 (7) Small et al [20] 2010 233 224 (96.1) 222 (95.2) 18 (7.7) Park et al [21] 2010 151 149 (98.6) 140 (92.7) 0 Branger et al [22] 2010 93 86 (92.5) 80 (86) 3 (3.2) Donnellan et al [23] 2010 43 40 (93) 40 (93) 2 (4.6) Lee JH et al [24] 2010 46 46 (100) 39 (84.8) 2 (4.3) Lee HJ et al [25] 2011 71 68 (95.8) 68 (94) 4 (5.6) Luigiano et al [26] 2011 39 36 (92.3) 35 (89.7) 2 (5.1) Jiménez-Pérez et al [27] 2011 182 177 (98) 141 (94) 5 (3) Tominaga et al [28] 2012 24 24 (100) 20 (83) 0 Yoshida et al [29] 2013 33 33 (100) 32 (97) 0 Bonfante et al [30] …”

No difference of complete or incomplete left-sided malignant colonic obstruction on both short- and long-term outcomes

“…In recent years, with the rise in the mortality and morbidity rates of CRC, malignant colonic obstruction has been causing more complicated clinical problems in CRC patients (Jimenez-Perez et al, 2011;Song and Baron, 2011;van Hooft et al, 2011). Surgical colectomy is still considered the best and final choice for the treatment of LMCO (Song and Baron, 2011;van Hooft et al, 2011).…”