Complications and survival in patients undergoing colonic stenting for malignant obstruction.
OBJECTIVE
To investigate whether predicting patients that might be at a higher risk for complications might serve to improve the selection of patients undergoing colonic stenting.


METHODS
A retrospective review of consecutive patients who underwent an attempted self-expandable metal stent (SEMS) insertion for malignant colonic obstruction between November 2006 and March 2013. All patients were either referred for preoperative colonic decompression with the intent of a single surgical procedure, or for palliation of the malignant colorectal obstruction for unresectable cancer. Fisher's test or χ(2) test was performed on categorical variables, and the t test for continuous variables. Univariable and multivariable logistic regression were used to examine the association between independent variables and the presence of complications from SEMS insertion.


RESULTS
SEMS insertion was attempted in 73 patients. Males comprised 55.71% and the mean age was 67.41 ± 12.41 years. Of these, 65.15% underwent subsequent surgery, while 34.85% received SEMS as palliation for advanced disease. Extracolonic tumors were only 4.76%. The majority of patients had stage IV disease (63.83%), while the remainder had stage III (36.17%). SEMS were successfully inserted in 93.85% (95%CI: 87.85%-99.85%). Perforations occurred in 4.10%, SEMS migration in 8.21%, and stent re-occlusion from ingrowth occurred in 2.74% of patients. The mean duration of follow up for the patients was 13.52 ± 17.48 mo (range 0-73 mo). None of the variables: age, sex, time between the onset of symptoms to SEMS insertion, time between SEMS insertion and surgery, length of the stenosis, location of the stenosis, albumin level, or receiving neoadjuvant chemotherapy, could predict the development of complications from either SEMS insertion nor prolonged survival.


CONCLUSIONS
None of the variables could predict the development of complications or survival. Further studies are required to identify patients who would benefit the most from SEMS.
Majid A Almadi, Nahla Azzam, Othman Alharbi, Alabbas H Mohammed, Nazia Sadaf, Abdulrahman M Aljebreen, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
Majid A
MA
Almadi
Nahla
N
Azzam
Othman
O
Alharbi
Alabbas H
AH
Mohammed
Nazia
N
Sadaf
Abdulrahman M
AM
Aljebreen
D000368:Aged; D016009:Chi-Square Distribution; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality; D003664:Decompression / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010166:Palliative Care; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
Colonic obstruction; Colonic stents; Colorectal cancer; Complications; Emergency surgery; Endoscopy; Enteric stenting; Palliative interventions; Self-expanding metal stent