Stenting of the colon in patients with malignant large bowel obstruction: a local experience.
OBJECTIVE
There is an increasing evidence base to support the use of self-expanding metallic gastrointestinal stents. In patients with colorectal cancer, they are used as a bridge to surgery and for palliation. The purposes of this study are to assess technical success, clinical outcome, complication rate and patency following colonic stent insertion in patients with colonic cancer at a local level and to compare our results with the current evidence base.


METHODS
A retrospective, two-centre study was conducted. Twenty-seven patients were included over a 5-year period. Six patients had undergone stent insertion as a bridge to surgery, and 21 had the procedure for palliation.


RESULTS
Initial technical success was achieved in 26 of 27 patients (96%). Of these 26 patients, clinical success was achieved in 24 patients (92%). Five patients (21%) suffered from stent re-occlusion, and one patient (4%) suffered from stent migration. There was one case (4%) of procedure-related perforation. Of the 19 palliative patients in whom clinical success was achieved, 17 (89%) were alive at 30 days, 13 (68%) at 90 (53%) days and 10 at 180 days. Average stent patency was 195 days.


CONCLUSIONS
WallFlex® self-expanding metallic gastrointestinal stents are a safe and effective means of alleviating obstructive symptoms in patients with colonic cancer requiring palliative treatment or as a bridge to surgery. Our data suggest that although a small percentage of patients are affected by stent re-occlusion, this does not contribute to premature mortality. They improve quality of life in palliative care patients as well as reducing premature morbidity and mortality caused by emergency surgery.
West
Malcolm
M
Department of General Surgery, St. Helens and Knowsley Teaching Hospitals, Whiston Hospital NHS Trust, Warrington Rd, Whiston, Prescot L35 5DR, UK. malcolmwest@nhs.net
Kiff
Robert
R
D000230:Adenocarcinoma / Q000150:complications* / Q000601:surgery; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male; D010166:Palliative Care; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome