Endoscopic stenting of acutely obstructing colorectal cancer: a 10-year review from a tertiary referral centre.
BACKGROUND
Insertion of self-expanding metallic stents for obstructing colorectal cancer (CRC) is a potential alternative to emergency resection, but evidence regarding efficacy is inconclusive. We aim to assess local efficacy of stent insertion for obstructing CRC, and to establish whether the service could be offered regionally.


METHODS
Retrospective patient data analysis using local paper notes and electronic records was performed. All patients underwent stent insertion for an obstructing CRC from April 2004 to March 2014. The main outcome measures were success of stent insertion, complications, further surgery and overall mortality.


RESULTS
Eighty-nine stent insertions were performed. Twenty-five were performed as a bridge to surgery, 49 due to advanced disease, 11 due to patient co-morbidity and four due to patient choice. Time from referral to stent insertion for emergency referrals was 1-360 h (median 23). Eighty-seven stents were successfully deployed. Perforation occurred in three patients and migration in nine patients. Twenty-one patients underwent planned surgery (time to surgery was 2-208 days, median 24), 14 patients underwent emergency surgery (time to surgery was 0-277 days, median 11). Forty-six patients have died since stent insertion (time to death was 0-42 months, median 6.04).


CONCLUSIONS
Stent insertion for obstructing CRC is a viable alternative to emergency resection, with a low complication rate. Stent insertion may allow a proportion of patients to later undergo planned surgery. Stent insertion carries a lower peri-procedure mortality than emergency resection. An acute stent insertion service for obstructing CRC could potentially be offered at regional level in our Trust.
Department of Colorectal Surgery, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK. rob.padwick@doctors.net.uk.
Robert T
http://orcid.org/0000-0001-5950-8544
RT
Padwick
Department of Colorectal Surgery, South Warwickshire Hospitals NHS Foundation Trust, Warwick, UK.
Vishnusai
V
Chauhan
Department of Clinical Sciences, Warwick Medical School, Coventry, UK.
Matthew
M
Newman
Department of Colorectal Surgery, South Warwickshire Hospitals NHS Foundation Trust, Warwick, UK.
James
J
Francombe
Department of Colorectal Surgery, South Warwickshire Hospitals NHS Foundation Trust, Warwick, UK.
Martin J
MJ
Osborne
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D062606:Tertiary Care Centers; D016896:Treatment Outcome
colorectal cancer; colorectal surgery; endoscopy; intestinal obstruction; stents