Endoscopic Palliation in Patients With Incurable Malignant Colorectal Obstruction by Means of Self-expanding Metal Stent

Manes, Gianpiero; Bellis, Mario De; Fuccio, Lorenzo; Repici, Alessandro; Masci, E.; Ardizzone, Sandro; Mangiavillano, Benedetto; Carlino, A.; Rossi, Giovanni Battista; Occhipinti, Pietro; Cennamo, Vincenzo

doi:10.1001/archsurg.2011.233

Cited by 115 publications

(99 citation statements)

References 24 publications

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“…In contrast, one study conducted in the same year as the previously cited randomised trial and using the WallFlex stent was associated with a perforation rate below 5% (19), which is in line with previous studies using other stents (11,14,20). The results of prospective trials and of recent retrospective studies further demonstrated the effectiveness of SEMS in the palliative management of malignant colorectal obstruction (6,7,(12)(13)(14)21). In this study, sustained relief of obstructive symptoms without reintervention was the primary outcome.…”

Section: Discussionsupporting

confidence: 88%

“…These results, however, conflict with other studies reporting short-and longterm clinical failure in more than 50% of patients, along with a high number of severe complications (4,5). Furthermore, several risk factors have been associated with stent patency, complications and clinical outcomes, as well as with conflicting results (1,6,(12)(13)(14). The question remains: are SEMS used for definitive palliation of malignant colorectal obstruction as successful as those used as a bridge to surgery?…”

Section: Introductionmentioning

confidence: 92%

“…Few studies followed the majority of patients until death after stent placement, and there is a small amount of long-term clinical outcomes data with conflicting results. Recent studies reported that a single palliative SEMS implantation is associated with long-term (until death) success rates up to 80%, although the complication rate is nearly 25% (6,7,12,13). These results, however, conflict with other studies reporting short-and longterm clinical failure in more than 50% of patients, along with a high number of severe complications (4,5).…”

Section: Introductionmentioning

confidence: 93%

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Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Liberato

Marques

et al. 2012

Rev. esp. enferm. dig.

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Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data.Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients' lives and related factors affecting stent patency, clinical success and complications.Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients' lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications.Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06).Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.Key words: Self-expanding metal stent. Colorectal obstruction. Endoscopic definitive palliation. INTRODUCTIONColorectal cancer is one of the most common malignancies worldwide (1). In patients with colorectal cancer, obstruction occurs in 15 to 20% (2). Most of these patients have advanced disease and are often elderly, with significant comorbidities (2-4). In this group of patients, curative resection is not frequently feasible (4,5). Therefore, palliation is the primary aim in these patients (3,6,7). Emergency surgical decompression is associated with high mortality and morbidity figures (8,9). In addition, surgery often involves creation of a...

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 93%

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Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Liberato

Marques

et al. 2012

Rev. esp. enferm. dig.

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“…15,55 Early perforation necessitates emergency surgery and may be associated with high mortality (reported as 50% in prospective and retrospective studies. 56,57 Stent migration and re-obstruction (caused by either tumour in-growth or inadequate stent expansion) can usually be managed endoscopically. Stentin-stent placement has reported success rates of 75% to 86% but there is a lack of data on long-term outcomes.…”

Section: Palliative Semsmentioning

confidence: 99%

“…Retrospective series suggested an increased perforation rate in those treated with bevacizumab (an angiogenesis inhibitor) (17%-50%). 22,57,59 A recent meta-analysis investigated risk factors for increased perforation rate. 25 Chemotherapy without bevacizumab was not associated with a significantly increased risk (7.0%), but use of bevacizumanb was (12.5%).…”

Section: Palliative Semsmentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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To Stent or Not to Stent

Efron¹

2011

Arch Surg

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Endoscopic Palliation in Patients With Incurable Malignant Colorectal Obstruction by Means of Self-expanding Metal Stent

Cited by 115 publications

References 24 publications

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Colonic cancer: The current role of stent insertion

To Stent or Not to Stent

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