The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer

BackgroundEndoscopic stenting is used to palliate malignant large bowel obstruction. A proportion of patients will develop recurrent obstruction due to tumour ingrowth and require reintervention. This study aimed to assess the outcome (clinical success and complication rates) of endoscopic reintervention compared with surgical intervention in patients with stent obstruction due to tumour ingrowth.MethodsThis was an observational study using data from a database of patients who underwent palliative colonic stenting between January 1998 and March 2017 at Christchurch Public Hospital.ResultsA total of 190 patients underwent colonic stent insertion, for palliation in 182 cases. Reintervention was performed in 55 (30·2 per cent). Thirty‐one patients (17·0 per cent) developed obstruction within the stent at a median of 4·6 (i.q.r. 2·3–7·7) months after the procedure. Of these, 21 had endoscopic restenting and ten underwent surgery. Restenting had technical and clinical success rates of 100 per cent, and involved a significantly shorter length of stay compared with surgery (median 2 (i.q.r. 1–4) versus 11 (6–19) days respectively; P = 0·006). Seven of the 21 patients in the restented group underwent a third palliative intervention. The overall stoma rate in the restented group was significantly lower than that in the surgical group (4 of 21 versus 10 of 10; P < 0·001). There was no difference in complications or survival between the two groups.ConclusionAmong palliative patients who develop malignant stent obstruction, endoscopic restenting had a high chance of technical success. It resulted in a shorter hospital stay and lower stoma rate than those seen after surgery.

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“…This rate is comparable to findings from other series5 15, 19 20. The median time to reintervention in this study was 4·6 (i.q.r.…”

Section: Discussionsupporting

confidence: 91%

“…Some 1–17 per cent of patients with a stent develop recurrent obstruction due to tumour ingrowth5 17, 18, 19. The options for further treatment at this stage are either surgery or reinsertion of a second stent within the first.…”

Section: Introductionmentioning

confidence: 99%

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

et al. 2017

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“…En 2011, Lee et al [46] ont comparé de manière rétros-pective les données des patients opérés en urgence à celles des patients pour lesquels il a été mis en place une prothèse colique. La prise en charge était considérée comme palliative lorsque les patients avaient des métastases hépatiques non résécables ou une maladie métastatique extrahépatique.…”

Section: La Prothèse Colique En Situation Palliativeunclassified

Place des prothèses coliques dans la stratégie thérapeutique du cancer colorectal

et al. 2014

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Messages• • Quelle que soit la situation, une discussion médicochirur-gicale doit avoir lieu avant toute décision thérapeutique.• • La pose d'une prothèse colique n'est pas recommandée en l'absence de signe clinique et radiologique d'occlusion, même lorsque la tumeur n'est pas franchissable par un endoscope. • • Si elle est indiquée, la pose de prothèse colique doit s'envisager dans les 12 à 24 heures suivant l'admission du patient. • • La prothèse colique est contre-indiquée en cas de perforation, de souffrance colique d'amont clinique et/ou radiologique, de cancer du bas et moyen rectum, d'occlusion du grêle par incarcération associée. • • La prothèse colique doit être mise en place par voie endoscopique et sous contrôle radiologique. • • La mise en place d'une prothèse colique doit être réali-sée par un opérateur entraîné et au sein d'une structure médico chirurgicale adaptée. • • L'utilisation de polyéthylène glycol (PEG) et d'autres préparations par voie orale est contre-indiquée. • • La dilatation préalable et le passage de la sténose tumorale par un endoscope de gros calibre sont à proscrire. • • En situation curative (tumeur non métastatique ou métas-tatique résécable, patient opérable), la prothèse colique ne peut pas être recommandée en première intention. Elle reste une option thérapeutique dans les centres experts, * Ces recommandations ont été publiées dans la revue Acta Endoscopica (2014) 4:208-18 Colon Rectum (2014) 8:172-182 173dans l'attente d'une validation par une étude randomisée. Dans cette situation curative, le traitement chirurgical de l'occlusion est à privilégier.• • En situation palliative (métastases non résécables, patient non opérable), la prothèse colique peut être recommandée en première intention. Dans cette situation, la chirurgie est une autre option thérapeutique.• • Chez les patients porteurs d'une prothèse colique, l'utilisation d'un traitement antiangiogénique peut entraîner des complications locales plus fréquentes (contre-indication relative), de même la pose d'une prothèse chez un patient traité par un traitement antiangiogénique est déconseillée.• • Les données d'efficacité à court terme des prothèses coliques sont globalement bonnes, par contre, il existe peu de données sur les résultats à long terme et chez les patients recevant secondairement un traitement de chimiothérapie associé ou non à une thérapie ciblée.

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“…Such complications occur in up to 30% of patients; however, it must be noted that patients receiving stents are often poor surgical candidates with highly advanced disease [11,89]. Such patient selection may also explain the poor 1-and 2-year survival rates of cases treated with SEMSs compared with surgical resection (16.7% and 2.8% vs 44.2% and 21.27%) [91]. When combined with bevacizumab, the risk of perforation increases [85].…”

Section: Non-surgical Management Of Malignant Obstructionmentioning

confidence: 99%

“…Techniques such as balloon dilatation and laser ablation have been reported to have low success in treating obstructions [90]. The optimal management for stage IV CC with obstruction remains controversial due to multiple treatment options and conflicting research outcomes often based on nonrandomized trials with a small sample size [90,91]. Nevertheless, appropriate treatment should be chosen by examination of the risks and benefits of each option in the context of each individualized patient's goals and expectations.…”

Section: Surgical Management Of Malignant Bowel Obstructionmentioning

confidence: 99%

Recent Advances in the Management of Stage IV Colon Cancer

Kanthan¹,

Senger²,

Ahmed³

et al. 2012

JCT

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Colon cancer is the second commonest cause of cancer-related death in Canadian men and women, with approximately one-third of patients dying from this disease. One quarter of patients present with metastases initially, and up to half of all colon cancer patients will develop stage IV disease over the course of their life. Despite ongoing advances in the evolution of newer cytotoxic drugs, targeted biological agents and improved metastasectomy techniques, the gain in overall survival in these patients is of low magnitude. This manuscript is a targeted review of the recent advances over the last decade in the management of advanced stage IV colon cancer as available in the published English literature. The two major arms of metastatic colon cancer management that include surgery and systemic chemotherapy and palliative measures as available are discussed. A multi-modality team-based approach involving medical oncologists, surgical oncologists, radiologists, and other health-care providers continues to be critical for ongoing success in the therapeutic management of these patients. Future studies of well-designed prospective, randomized-controlled clinical trials to develop and evaluate newer therapeutic strategies are recommended for continued and improved understanding for optimization of clinical management in advanced colon cancer.

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The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer

Cited by 48 publications

References 21 publications

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Place des prothèses coliques dans la stratégie thérapeutique du cancer colorectal

Recent Advances in the Management of Stage IV Colon Cancer

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