Systemic Chemotherapy is a Promising Treatment Option for Patients with Colonic Stents: A Review

Abstract

Approximately 10% of patients with colorectal cancer (CRC) develop malignant large bowel obstruction (MLBO) at diagnosis. Furthermore, for 35% of patients with MLBO, curative primary tumor resection is unfeasible because of locally advanced disease and comorbidities. The practice of placing a self-expandable metallic stent (SEMS) has dramatically increased as an effective palliative treatment. Recent advances in systemic chemotherapy for metastatic CRC have significantly contributed to prolonging patients' prognosis and expanding the indications. However, the safety and efficacy of systemic chemotherapy in patients with SEMS have not been established. This review outlines the current status of this relatively new therapeutic strategy and future perspectives. Some reports on this topic have demonstrated that 1) systemic chemotherapy and the addition of molecular targeted agents contribute to prolonged survival in patients with SEMS; 2) delayed SEMS-related complications are a major concern, and this requires strict patient monitoring; however, primary tumor control by chemotherapy might result in decreased complications, especially regarding re-obstruction; and 3) using bevacizumab could be a risk factor for SEMS-related perforation, which may be lethal. Although this relatively new approach for unresectable stage IV obstructive CRC requires a well-planned clinical trial, this therapy could be promising for patients who are unideal candidates for emergency surgery and require immediate systemic chemotherapy.

Management of obstructive colon cancer: Current status, obstacles, and future directions

“…In obstructive colon cancer, the ESGE guidelines updated in 2020 recommend that the treatment strategy of SEMS placement followed by neoadjuvant chemotherapy is occasionally used in patients with stage IV disease for the early and safe introduction of systemic chemotherapy[ 47 ]. In a review article, Matsuda et al [ 74 ] suggested that systemic chemotherapy after SEMS placement may be an optimal treatment for patients with unresectable metastatic disease who are unfit for emergency surgery. However, the authors warned of delayed stent-related complications that require strict monitoring[ 74 ].…”

“…In a review article, Matsuda et al [ 74 ] suggested that systemic chemotherapy after SEMS placement may be an optimal treatment for patients with unresectable metastatic disease who are unfit for emergency surgery. However, the authors warned of delayed stent-related complications that require strict monitoring[ 74 ]. Additionally, the use of bevacizumab should be avoided because bevacizumab is a risk factor for stent-related perforation[ 74 ].…”

“…However, the authors warned of delayed stent-related complications that require strict monitoring[ 74 ]. Additionally, the use of bevacizumab should be avoided because bevacizumab is a risk factor for stent-related perforation[ 74 ]. Nevertheless, for patients with stage IV obstructive colon cancer, an optimal outcome of upfront treatment for colonic obstruction would require immediate symptomatic control and minimizing complications related to emergent treatment for subsequent treatment for systemic disease.…”

Utility and safety of the self‐expandable metallic colonic stent in Japanese patients who received systemic chemotherapy or palliative treatment for obstructive primary advanced colorectal cancer: A retrospective single‐center medical chart evaluation

“…[1][2][3] Obstructive stenosis of the ileus or sub-ileus is a serious complication of advanced colorectal cancer. 2,3 Colonic stenting is globally the preferred method of releasing the obstruction. 4 The method has been widely applied in Japan since 2012 for relieving obstruction caused by colorectal cancer after health insurance approval.…”

“…Regarding surgical outcomes, the advantages and disadvantages of colonic stenting for bridging for surgery were compared with those for emergency surgery and the trans‐anal decompression tube in Japanese studies and were found to be controversial 18–22 . Several studies that focused on the clinical safety and effectiveness of the self‐expandable colonic stent have been conducted in the last 3 years in Japan, most of which were limited to advanced colon cancer patients who were bridged before surgical curative therapy 1–3,5–11 . The present study aimed to compare the utility (technical and clinical success rates) and the safety (rate of early and late complications after stent placement) of the colonic stent between patients who received systemic chemotherapy or palliative treatment and the best supportive care and patients who were bridged for surgery.…”