Self-Expanding Metal Stenting for Malignant Colonic Tumours: A Prospective Study

Wissam Al-Jundi, Sameer Kadam, Ioakim Giagtzidis, Feras Ashouri, Kunal Chandarana, Mark Downes, Amjad Khushal

.

DOI: 10.4236/ss.2011.23032                

Abstract

Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance.

Keywords

Self-Expanding Metal Stent; Stent; Colon/Colonic Obstruction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. T. Deans, Z. H. Krukowski and S. T. Irwin, “Malignant Obstruction of the Left Colon,” British Journal of Surgery, Vol. 81, No. 9, 1994, pp. 1270-1276. doi:10.1002/bjs.1800810905
[2]	D. G. Adler and S. N. Merwat, “Endoscopic Approaches for Palliation of Luminal Gastrointestinal Obstruction,” Gastroenterology Clinics of North America, Vol. 35, No. 1, 2006, pp. 65-82. doi:10.1016/j.gtc.2005.12.004
[3]	M. Dohmoto, “New Method: Endoscopic Implantation of Rectal Stent in Palliative Treatment of Malignant Stenosis,” Endoscopy Digest, Vol. 3, 1991, pp. 1507-1512.
[4]	G. J. Harris, A. J. Senagore, I. C. ALavery, et al., “The Management of Neoplastic Colorectal Obstruction with Colonic Endoluminal Stenting Devices,” American Journal of Surgery, Vol. 181, No. 6, 2001, pp. 499-506. doi:10.1016/S0002-9610(01)00622-5
[5]	U. P. Khot, A. W. Lang, K. Murali, et al., “Systematic Review of the Efficacy and Safety of Colorectal Stents,” British Journal of Surgery, Vol. 89, No. 9, 2002, pp. 1096-1102. doi:10.1046/j.1365-2168.2002.02148.x
[6]	M. Keymling, “Colorectal Stenting,” Endoscopy, Vol. 35, No. 3, 2003, pp. 234-238. doi:10.1055/s-2003-37265
[7]	S. Sebastian, S. Johnston, T. Geoghegan, et al., “Pooled Analysis of the Efficacy and Safety of Self-Expanding Metal Stenting in Malignant Colorectal Obstruction,” American Journal of Gastroenterology, Vol. 99, No. 10, 2004, pp. 2051-2057. doi:10.1111/j.1572-0241.2004.40017.x
[8]	B. H. Rosario, P. Hurlstone, F. Lee and T. Downes, “Stenting: An Alternative to Surgery in the Elderly,” Age Ageing, Vol. 36, No. 5, 2007, pp. 593-595. doi:10.1093/ageing/afm080
[9]	P. W. K. Lau and T. G. Lorentz, “Results of Surgery for Malignant Bowel Obstruction in Advanced, Unresectable, Recurrent Colorectal Cancer,” Diseases of the Colon & Rectum, Vol. 36, No. 1, 1993, pp. 61-64. doi:10.1007/BF02050303
[10]	M. A. G. Sprangers, B. G. Taal, N. K. Aaronson, A. te Velde, “Quality of Life in Colorectal Cancer,” Diseases of the Colon & Rectum, Vol. 38, 1995, pp. 361-369. doi:10.1007/BF02054222
[11]	B. O. Olubaniyi, C. D. McFaul, V. S. K. Yip, G. Abbott and M. Johnson, “Stenting for Large Bowel Obstruction – Evolution of a Service in a District General Hospital,” Annals of The Royal College of Surgeons of England, Vol. 90, No. 3, 2008, pp. 181-186.
[12]	A. M. Watt, I. G. Faragher, T. T. Griffin, N. A. Rieger and G. J. Maddern, “Self-Expanding Metallic Stents for Relieving Malignant Colorectal Obstruction: A Systematic Review,” Annals of Surgery, Vol. 246, No. 1, 2007, pp. 24-30. doi:10.1097/01.sla.0000261124.72687.72
[13]	H. Singh, S. Latosinsky, B. M. R. Spiegel and L. E. Targownik, “The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective,” Canadian Journal of Gastroenterology, Vol. 20, No. 12, 2006, pp. 779-785.
[14]	J. E. Van Hooft, W. A. Bemelman, R. Breumelhof, et al., “Colonic Stenting as Bridge to Surgery versus Emergency Surgery for Management of Acute Left-Sided Malignant Colonic Obstruction: A Multicenter Randomized Trial (Stent-In 2 Study),”BMC Surgery, Vol. 7: 2007, p. 12. doi:10.1186/1471-2482-7-12
[15]	G. L. de Salvo, C. Gava, S. Pucciarelli and M. Lise, “Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection?” Cochrane Database of Systematic Reviews, Vol. 2. Art. No. CD002101, 2002.