Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes.
OBJECTIVE
This study was designed to evaluate the outcomes of self-expanding metallic stents as a palliative treatment for malignant obstruction of the colon and rectum.


METHODS
The insertion of self-expanding metallic stents was attempted for palliation in 52 patients (33 males; mean age, 66.5 +/- 16.4 years) with colorectal obstruction caused by advanced malignancies. The stents were inserted under endoscopic and fluoroscopic guidance. The data on the success of the procedure, the complications, and the outcomes of the patients were collected prospectively.


RESULTS
Thirty patients had locally advanced or disseminated primary colorectal cancers, and 22 had recurrent cancer of colorectal or other primaries. Successful insertion of the stent was achieved in 50 patients. The median survival of the patients was 88 (range, 3-450) days. Complications occurred in 13 patients (25 percent). These included perforation of the colon (n=1), migration or dislodgement of the stents (n=8), severe tenesmus (n=1), colovesical fistula (n=1), and tumor ingrowth (n=2). Insertion of a second stent was required in eight patients. Subsequent operations were performed in nine patients, and stoma creation was required in seven patients.


CONCLUSIONS
Self-expanding metallic stents are highly effective in relieving malignant colorectal obstruction. The complication rate is acceptable and palliation can be achieved in the majority of the patients without a stoma.
Law
Wai Lun
WL
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong. lawwl@hkucc.hku.hk
Choi
Hok Kwok
HK
Lee
Yee Man
YM
Chu
Kin Wah
KW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D008670:Metals