Impact of peritoneal carcinomatosis on clinical outcomes of patients receiving self-expandable metal stents for malignant colorectal obstruction

Jae Jun Park; Kwangwon Rhee; Jin Young Yoon; Soo Jung Park; Joo Hee Kim; Jie-Hyun Kim; Young Hoon Youn; Tae Il Kim; Hyojin Park; Won Ho Kim; Jae Hee Cheon

doi:10.1055/a-0657-3764

Endoscopy, Table of Contents

Endoscopy 2018; 50(12): 1163-1174
DOI: 10.1055/a-0657-3764

Original article

Impact of peritoneal carcinomatosis on clinical outcomes of patients receiving self-expandable metal stents for malignant colorectal obstruction

Jae Jun Park

¹Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Kwangwon Rhee

¹Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Jin Young Yoon

²Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea

,

Soo Jung Park

³Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Joo Hee Kim

⁴Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Jie-Hyun Kim

¹Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Young Hoon Youn

¹Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Tae Il Kim

³Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Hyojin Park

¹Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Won Ho Kim

³Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

,

Jae Hee Cheon

³Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

› Author Affiliations

Abstract

Background Peritoneal carcinomatosis can influence clinical outcomes of patients receiving self-expandable metal stents (SEMS) for malignant colorectal obstruction, but data regarding this issue are sparse. We analyzed the clinical outcomes of post-SEMS insertion for malignant colorectal obstruction based on carcinomatosis status.

Methods Stent- and patient-related clinical outcomes were compared for carcinomatosis status in a retrospective review involving 323 consecutive patients (colorectal cancer 198 patients; extracolonic malignancy 125 patients) who underwent palliative SEMS placement for malignant colorectal obstruction from January 2005 to March 2012. Severity of carcinomatosis was classified as mild, moderate, or severe.

Results Carcinomatosis was observed in 190 patients (58.8 %). The rates of technical (84.7 vs. 94.7 %; P = 0.005) and clinical (73.2 vs. 83.5 %; P = 0.03) success were lower in patients with vs. without carcinomatosis. Rates of early (2.1 % vs. 3.0 %; P = 0.72) and delayed (1.6 % vs. 6.0 %; P = 0.08) perforation and stent failure (27.9 % vs. 26.3 %; P = 0.75) showed no difference. Technical and clinical success rates were significantly different based on the severity of carcinomatosis (technical success rate: mild 90.7 %, moderate 97.4 %, severe 76.3 %, P = 0.003; clinical success rate: mild 83.3 %, moderate 82.1 %, severe 63.9 %, P = 0.01). In multivariate analysis, severe carcinomatosis was identified as an independent factor related to technical (odds ratio [OR] 0.18, 95 % confidence interval [CI] 0.06 – 0.56) and clinical (OR 0.33, 95 %CI 0.15 – 0.74) success.

Conclusions Peritoneal carcinomatosis was associated with decreased technical and clinical success rates in patients receiving SEMS for malignant colorectal obstruction. Moreover, the presence of severe carcinomatosis was an independent factor determining these clinical outcomes.

Full Text

References

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