title: Insertion of a Stent in Obstructive Colon Cancer Can Induce a Metastatic Process in an Experimental Murine Model.
abstract: BACKGROUND
  Colonic self-expanding metallic stents (SEMS) are used in obstructive colorectal cancer patients as a bridge to surgery. However, its oncologic safety remains uncertain. Therefore, we attempted to clarify this further with an experimental study and constructed a mouse model of colonic cancer.
  
  
  METHODS
  CT26 cells were injected in the rectal wall, and to mimic SEMS, a cardiac stent was inserted under endoscopy in occlusive (75 % lumen occlusion) tumors. We set up a control group (n = 22) and a stent group (n = 16), and the findings were compared. We focused on serum lactate dehydrogenase (LDH) concentrations, circulating tumor cells, survival time, peritoneal carcinomatosis, liver metastases, and bioluminescence.
  
  
  RESULTS
  One week after stent insertion, the serum LDH concentrations were significantly higher in the stent group (506 ± 203 IU/L) compared to the controls (229 ± 52 IU/L) (P = 0.005). The average survival time before sacrifice was significantly lower in the stent group (15.2 ± 1 days) compared to the controls (20 ± 5 days) (P = 0.005). The presence of a peritoneal carcinomatosis was more frequently observed in the stent group (75 %) than in the controls (50 %). Liver metastases were observed in 19 % of the stent group compared to the controls (4.5 %) (P = 0.29). After multivariate analysis, the stent group was still found to be associated with significantly lower survival time (P = 0.002).
  
  
  CONCLUSIONS
  These observations led us to conclude that in our mouse model, SEMS resulted in an increased metastatic process and a shorter survival time. We suggest, therefore, that the utmost caution be exercised when opting for a stent as a bridge to surgery.
authors.affiliation: UMR INSERM 965-Carcinomatosis Angiogenesis and Translational Research Lab, Lariboisière Hospital, Paris, France. bricemalgras@hotmail.com.|Oncologic and Digestive Surgical Unit, Lariboisière Hospital, Paris, France. bricemalgras@hotmail.com.
authors.forename: Brice
authors.initials: B
authors.lastname: Malgras
authors.affiliation: Unité UMR 144, Institut Curie, Paris, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Brullé
authors.affiliation: UMR INSERM 965-Carcinomatosis Angiogenesis and Translational Research Lab, Lariboisière Hospital, Paris, France.|Oncologic and Digestive Surgical Unit, Lariboisière Hospital, Paris, France.|Université Diderot, Paris, France.
authors.forename: Réa
authors.initials: R
authors.lastname: Lo Dico
authors.affiliation: Unité UMR 144, Institut Curie, Paris, France.
authors.forename: Fatima
authors.initials: F
authors.lastname: El Marjou
authors.affiliation: Unité UMR 144, Institut Curie, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Robine
authors.affiliation: UMR INSERM 965-Carcinomatosis Angiogenesis and Translational Research Lab, Lariboisière Hospital, Paris, France.|Université Diderot, Paris, France.
authors.forename: Amu
authors.initials: A
authors.lastname: Therwath
authors.affiliation: UMR INSERM 965-Carcinomatosis Angiogenesis and Translational Research Lab, Lariboisière Hospital, Paris, France.|Oncologic and Digestive Surgical Unit, Lariboisière Hospital, Paris, France.|Université Diderot, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
mesh_terms: D000818:Animals; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D004195:Disease Models, Animal; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary*; D051379:Mice; D010534:Peritoneal Neoplasms / Q000556:secondary*; D015607:Stents / Q000009:adverse effects*