Colorectal stenting for malignant obstruction: an 8-year clinical experience

Short-term outcomes of stents in obstructive rectal cancer: A systematic review and meta-analysis

BACKGROUND

With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients.

METHODS

We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates.

RESULTS

We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I² = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I² = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I² = 79.3%, P < 0.001).

CONCLUSION

The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.

Management of Colorectal Cancer Patients Undergoing a Colonic Stenting: A Multidisciplinary Team Approach

Colonic stent procedure is one of the best therapeutic medical interventions for managing a colorectal cancer patient with large bowel obstruction. This is a retrospective study that evaluated data from the past 10 years; it examined the epidemiological and clinical data of patients with colorectal cancer undergoing a colonic stent procedure. In addition, this study prospectively evaluated the nurse's roles during a colonic stent procedure, and at the same time, it explored the patient's satisfaction with the procedure at the Hospital Universitario Central de Asturias (Spain). The results revealed that for the last 10 years, a total of 102 patients underwent a colonic stent procedure. Male patients outnumbered female patients by 2:1. The palliative group consisted of patients with multiple cancer metastases, elderly patients, and patients with other comorbidities, whereas the preoperative group comprised those patients with fewer comorbidities and no multiple cancer metastases. Survival time in the palliative group was 3 months without any aggressive treatment, whereas patients with a favorable condition and fit for surgery after a colonic stent procedure had a survival time of 28 months. In the prospective study, nurses implemented care in terms of a multidisciplinary team approach of safety culture that included patient safety, equipment safety, and environment and procedure safety. Therefore, the level of patient satisfaction was high. In conclusion, management of a colorectal cancer patient undergoing colonic stenting performed at the Hospital Universitario Central de Asturias has high technical and clinical success, and it is a quality procedure that includes a multidisciplinary team approach.

Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice

Introduction

Colorectal cancer presents itself as acute bowel occlusion in 10–40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS).

Aims and Methods

This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013.

Results

Globally (85 patients – 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004).

Conclusion

SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.

Kolonstents als «Bridge to Surgery»

<b><i>Hintergrund: </i></b>Die Implantation von selbstexpandierenden Metallstents (SEMS) in das Kolorektum – insbesondere als «bridge to surgery» – hat sich zunehmend etabliert, obwohl die Charakteristika des Kolons eine Prothesenimplantation erschweren und bisher noch keine optimalen Stents für diese Lokalisation verfügbar sind. Mit einem Stent lässt sich beim Kolonileus sehr patientenschonend eine sofortige Dekompression des Darms herbeiführen und die sonst notwendige Notfalloperation mit hoher Letalität und Komplikationsrate vermeiden. <b><i>Methode: </i></b>Literaturübersicht. <b><i>Ergebnisse: </i></b>Trotz zahlreicher positiver Studienergebnisse («... Stenting ist sehr effektiv, sicher und komplikationsarm im Vergleich zur Operation ...») ergibt eine kritische Analyse der Publikationen aufgrund vieler Faktoren (Patientenselektion, Stenttyp, Implantationsmethode usw.) jedoch eine hohe Heterogenität. <b><i>Schlussfolgerungen: </i></b>Um gute Resultate zu erzielen, sollte eine Stentimplantation ins Kolon nur nach strenger Indikationsstellung von einem erfahrenen Endoskopiker durchgeführt werden. Dabei ist auch die mögliche Alternative einer endoskopisch eingelegten Dekompressionssonde zu prüfen; ebenso sind onkologische Gesichtspunkte (chirurgische Resektion als einziger kurativer Ansatz) zu beachten.