Self-Expandable Metal Stents for Colorectal Cancer: From Guidelines to Clinical Practice

Abstract

IntroductionColonic self-expandable metal stent placement is widely used for palliation of obstructive colorectal cancer. The European recommendations for stent placement as a bridge to elective surgery in obstructive colorectal cancer were recently reviewed. The aim of this study was to evaluate the efficacy and safety of stent placement in obstructive colorectal cancer and to discuss these recent guidelines.Materials and methodsDemographic characteristics, procedure indications, complications and final outcome in patients with obstructive colorectal cancer who underwent endoscopic stent placement between January 2012 and June 2015 were retrospectively analyzed. Statistical analysis was performed with SPSS V22.ResultsThirty-six patients were included, 20 (56%) women, mean age 70.6 ± 10.9 years. Stent placement as a bridge to elective surgery was performed in 75% (n = 27) of patients and with palliation intent in 25% (n = 9). In 94% (n = 34) of procedures, technical and clinical success was achieved. A total of eleven (11%) complications were observed: 2 migrations and 9 perforations. No procedure related death was recorded. When stents were placed as a bridge to surgery, average time between endoscopic procedure and surgery was 11.7 ± 9.4 days (excluding three patients who underwent neoadjuvant chemotherapy). Six perforations were recorded in this group: one overt and five silent (three during surgery and two after histopathological examination of the resected specimen). Twenty-one patients underwent adjuvant chemotherapy. During the follow-up period of 14.7 ± 10.9 months recurrence was observed in five patients. None of the recurrence occurred in the group of patients with perforation.ConclusionsIn this study, stent placement was an effective procedure in obstructive colorectal cancer. It was mainly used as a bridge to elective surgery. However, a significant rate of silent perforation was observed, which may compromise the oncological outcome of these potentially curable patients. Prospective real life studies are warranted for a better definition of actual recommendations.

Successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy: A case report

“…SEMS placement has been applied over 20 years for the treatment of colonic obstruction[7]. As the stent type has evolved, colonic stents have been used to treat colonic malignancies either as a bridge to surgery or as a palliative measure[8,9]. As a bridge to surgery, the use of stents for potentially resectable colorectal cancers makes it possible to convert urgent to elective surgery.…”

Colonic Stent Use in Patients With Malignant Flexure Tumors Presenting With Obstruction

“…Single case series or series consisting of several cases have been reported in the literature. In a case series consisting of 36 cases, Costa Santos et al 14 reported that stenting was successfully performed in 2 cases with splenic flexura tumors. Similarly, stent application in cases with splenic flexura tumors was reported by Alcántara et al 15 in 6 patients, Arezzo et al 16 in 18 patients, Ho et al 17 in 4 patients, and Pirlet et al 18 in 3 patients.…”

Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head

“…It is the only procedure that allows for non-resectable jaundiced patients to be treated with neoadjuvant therapy [ 9 ], and a biopsy can be performed in the same intervention in order to reach a definitive diagnosis [ 10 ]. Furthermore, it allows for resectable patients to safely wait for surgical resection when it cannot be performed in a short-term period when they develop severe pruritus, severe hyperbilirubinemia, acute cholangitis, or jaundice-related systemic complications [ 11 , 12 ]. This procedure is not routinely recommended for patients taken in for surgical resection, as it can increase complications [ 5 ], and formal indications for its use are still debated [ 8 ].…”

“…Some studies have shown that PBD is associated with a decrease in the rate of postoperative complications [ 8 , 13 ], while others have shown that this would be the same whether or not patients underwent PBD [ 11 , 14 , 15 ]. However, what seems to be the increasing consensus is that it leads to an increase in the rate of postoperative complications, especially infectious ones [ 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”