Palliation of malignant rectal obstruction with self-expanding metal stents.
BACKGROUND
Surgical management of patients with metastatic or recurrent rectal cancer remains controversial. Self-expanding metal stents are increasingly used for palliative treatment of advanced tumors, although long-term results are not yet available.


METHODS
Between 1996 and 2003, 521 patients underwent surgery for rectal neoplasms. In the same time period, self-expanding metal stents were used for palliation of 34 patients with malignant rectal obstruction and incurable disease. The outcome of the patients was analyzed retrospectively.


RESULTS
Rectal stents were successfully placed in 33 of 34 patients (97%) without major complications. Early failure occurred in 7 patients (21%) because of stent migration, pain, or incontinence. Long-term success with a mean patency of 5.3 months was observed in 26 patients (79%), but restenting was required in 2 patients. Despite the initial success of stenting, a colostomy was created in 2 other patients after 3.4 months and 9.2 months because of incontinence and rectovesical fistula. Overall, 6 of 33 patients (18%) underwent palliative surgery because of early complications (n = 4) or long-term failure of stent treatment (n = 2).


CONCLUSIONS
Self-expanding metal stents are useful to avoid a colostomy in selected patients with incurable rectal cancer and limited life expectancy. Nonetheless, a considerable number (18%) of patients will require surgical palliation because of failure of stent treatment.
Hünerbein
Michael
M
Department of Surgery and Surgical Oncology, Charité Campus Bach, Robert-Roessle-Hospital and Helios Hospital Berlin, Lindenberger Weg 80, 13125 Berlin, Germany.
Krause
Matthias
M
Moesta
Kurt T
KT
Rau
Beate
B
Schlag
Peter M
PM
D000368:Aged; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D010166:Palliative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome