Usefulness of a Colonic Stent for Colonic Obstruction Caused by Lung Cancer Metastasis

Abstract

The gastrointestinal tract is not a common site for metastasis from lung cancer, and colonic metastases are especially rare. Although surgical intervention can improve colonic obstruction, perioperative mortality is high in patients with advanced malignancy, and these patients experience a significant deterioration in quality of life postoperatively. This report describes an uncommon case of colonic metastasis from non-small cell lung cancer (NSCLC), in which colonic obstruction was improved with a selfexpanding metallic stent. A 62-year-old man was admitted to our hospital for progressively worsening abdominal pain. He had been treated with immunotherapy and chemotherapy after being diagnosed with NSCLC (T4N2M1) 1.5 years earlier. Enhanced computed tomography showed intestinal obstruction and a mass in the colon at the hepatic flexure. Histopathological analysis of a biopsy specimen confirmed NSCLC metastasis. Considering his general condition, endoscopic stenting was chosen as an urgent decompression procedure. He was discharged 45 days after stenting and was able to resume immunotherapy. Emergency stenting could be offered at experienced centers when operative intervention is not part of the treatment plan, as it is safe and improves the efficiency of care along with the quality of life.

Successful resection of colonic metastasis of lung cancer after colonic stent placement: A case report and review of the literature

“…There was no specific distribution of colonic metastases. Seven patients (29.2%) had regional lymph node metastasis of the colorectum[ 14 , 28 , 34 , 41 ], and five patients (20.8%) had distant metastasis other than the colorectum such as the liver[ 46 ], stomach[ 47 ], small intestine[ 35 , 48 ], bone[ 49 ], and the bilateral lung[ 25 ]. Most colonic metastases showed the histological appearance of adenocarcinoma (11 patients); squamous cell carcinoma was observed in 7, pleomorphic carcinoma in 2, small cell carcinoma in 2, and adenosquamous cell carcinoma in 2 patients, which were naturally identical to the primary lung cancer.…”

“…Although systemic chemotherapy is the standard treatment for lung cancer with GI metastasis, it cannot be used in cases associated with abdominal symptoms, such as abdominal pain, bleeding, and bowel obstruction, due to GI metastasis. Tumor resection[ 17 , 30 ], colostomy[ 14 , 48 ], and SEMS[ 49 ], followed by chemotherapy, have been reported in such patients. Although the usefulness of SEMS as a bridge to surgery for primary colorectal cancer is accumulating[ 50 - 54 ], little is known regarding the application of SEMS for metastatic colonic stricture.…”