Self-Expandable Metal Stent for Malignant Colonic Obstruction: Outcome in Proximal vs. Left Sided Tumor Localization

Abstract

Introduction: The aim of this study was to evaluate the outcome of through-the-scope (TTS) implanted self-expanding metal stent (SEMS) comparing left-sided vs. proximal placement with regard to complications and outcome in palliation of malignant colorectal obstruction.

Material and Methods: All patients were consecutively retrospectively enrolled to this study between January 2009 and February 2012 due to impending or prevalent complete malignant colorectal obstruction. TTS applicable uncovered nitinol SEMS with unique flexible properties were used (Taewoong Medical, South Korea). Left-sided obstruction (aboral from the left flexure) was compared to proximal (from the ileo-cecal valve to the left flexure) localization. All patients have been discussed in the interdisciplinary tumor conference and the recommendation to treat by endoscopic stent placement was given in consensus.

Results: A total of 15 patients was enrolled to this study (10 male and 5 female; mean age 68.3 ± 15.4 years, range 48 − 94), five patients with obstructions located in the proximal hemicolon whereas ten patients had a left-sided malignancy. Technical success was achieved in all cases and there was no early complication noticed. Three late complications included tumor overgrowth (n = 1), stent occlusion (1), and dislocation (1). Stent-in-stent insertion achieved, again, clinical success. The site of SEMS implantation (proximal vs. left colon) had no impact on patient outcome or complication rate. SEMS patency duration was 269.8 ± 175.2 days (range 30 − 570) and mean survival of the patients was 305.1 ± 279.3 days (range 16 − 990).

Conclusion: TTS application of flexible, non-covered SEMS seems to be safe and effective for palliation of malignant colorectal obstruction independent of localization of the tumor in the colon.

Zusammenfassung

Einführung: Ziel dieser Studie ist die Überprüfung des „outcomes“ bei Patienten nach Einlage einer selbst expandierenden Metallendoprothese (SEMS) ‚through-the-scope‘ (TTS) bei maligner Stenose des Kolons. Es wird die linksseitige mit einer proximalen Tumorlokalisation verglichen und Komplikationen und Erfolg der Therapie evaluiert.

Material und Methoden: Alle Patienten, die zwischen Januar 2009 und Februar 2012 mit einem SEMS behandelt worden sind, wurden konsekutiv in die Studie eingeschlossen. Es wurde ein SEMS mit besonders hoher Flexibilität eingesetzt (Taewoong Medical, South Korea). Ein linksseitiger Tumorbefall wurde mit einem Befall proximal der linken Kolonflexur verglichen. Alle Patienten wurden in der interdisziplinären Tumorkonferenz besprochen und die Stenteinlage erfolgte nach gemeinsamer Board-Empfehlung.

Ergebnisse: 15 Patienten wurden in die Studie eingeschlossen (10 Männer, 5 Frauen; mittleres Alter 68,3 ± 15,4 Jahre, Spannweite 48 − 94 Jahre). Fünf Patienten wiesen einen Verschluss des proximalen Hemikolons auf und 10 Patienten hatten eine Tumorstenose im linksseitigen Kolon. Technischer Erfolg trat bei allen Patienten ein und frühe Komplikationen wurden nicht beobachtet. In 3 Fällen traten späte Komplikationen ein: Überwachsen des SEMS durch den Tumor (n = 1), Okklusion des Stents (1) und Dislokation nach Therapie mit Chemotherapeutika (1). Eine Stent-in-Stent-Einlage führe erneut zu einem klinischen Erfolg der Behandlung. Der Ort der Stenteinlage (proximal vs. linksseitiges Kolon) hatte keinen Einfluss auf den Erfolg der Therapie, den klinischen Erfolg oder auf die Komplikationsrate. Die Offenheitsdauer des SEMS betrug 269,8 ± 175,2 Tage (30 − 570) und das mittlere Überleben der Patienten betrug 305,1 ± 279,3 Tage (16 − 990).

Schlussfolgerung: Die Einlage von nicht ummantelten SEMS in TTS-Technik ist sicher und effektiv in der Behandlung von malignen Kolonstenosen, unabhängig von der Lokalisation des Tumors im Kolon.

Schlüsselwörter

kolorektales Karzinom - Kolon - selbst expandierende Metallstents - Endoskopie - maligne Kolonstenosen - Kolonoskopie

Key words

colorectal carcinoma - colon - self-expanding metal stent - endoscopy - tumor obstruction - colonoscopy

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