title: Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction.
abstract: BACKGROUND
  self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data.
  
  
  OBJECTIVE
  this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients lives and related factors affecting stent patency, clinical success and complications.
  
  
  METHODS
  this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications.
  
  
  RESULTS
  technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06).
  
  
  CONCLUSIONS
  for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.
authors.affiliation: Department of Gastroenterology, Pulido Valente Hospital, Faculty of Medical Sciences, Lisbon, Portugal. jmtcanena@live.com.pt
authors.forename: Jorge Manuel
authors.initials: JM
authors.lastname: Canena
authors.forename: Manuel
authors.initials: M
authors.lastname: Liberato
authors.forename: Inês
authors.initials: I
authors.lastname: Marques
authors.forename: Catarina Isabel
authors.initials: CI
authors.lastname: Rodrigues
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Lagos
authors.forename: Sara Daniela
authors.initials: SD
authors.lastname: Patrocínio
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Tomé
authors.forename: Eduardo Nuno
authors.initials: EN
authors.lastname: Cpires
authors.forename: Carlos
authors.initials: C
authors.lastname: Romão
authors.forename: António Pereira
authors.initials: AP
authors.lastname: Coutinho
authors.forename: Pedro Miguel
authors.initials: PM
authors.lastname: Veiga
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Neves
authors.forename: João Reis
authors.initials: JR
authors.lastname: Deus
authors.forename: Hélder Daniel
authors.initials: HD
authors.lastname: Além
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Gonçalves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome