Outcomes of Palliative Colonic Stent Placement in Malignant Colonic Obstruction: Experience from a Tertiary Care Oncology Center in India

Abstract

Introduction Colonic self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analyzed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology center in Western India.

Methods Retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 and September 2021. Demographic details, intent of stent placement, site of obstruction, length of stricture, technical success of stenting, clinical success, and complications (both immediate and long term) were noted.

Results Sixty-one patients underwent colonic SEMS placement during the study period (mean age 53.6 years, 50.7% men). Obstruction was due to primary colonic malignancy in 43 (70.5%) patients and extracolonic malignancies in 18 (29.5%) patients. Most common extracolonic malignancy was gallbladder cancer in 8 (44.4%) patients. Most common site of obstruction was sigmoid colon in 18 (29.5%) patients. Proximal colonic obstruction was seen in 17 (27.9%) patients. Peritoneal metastases were seen in 26 (42.6%) patients. Colonoscopy revealed an impassable stenosis in 58 (95.1%) patients. Median length of stricture was 5 cm (range 2–9 cm). Technical success was achieved in 98.3% (60/61). Clinical success was achieved in 51 (86.4%) patients. Perforation during colonic SEMS placement was seen in 2 (3.4%) patients. Stent migration was seen in 3 (5.9%) patients, needing surgery for retrieval in all 3 patients. Over a median follow-up of 9 months (0–21 months), stent block was seen in 7 (13.7%) patients. Stent block developed after a median period of 6 months. Of these patients, three patients underwent SEMS placement within the SEMS and the other four patients underwent surgery.

Conclusion Colonic SEMS placement achieves good palliation of malignant colonic obstruction in approximately 87% patients. Long-term complications like obstruction occur in a few patients after a median duration of 6 months.

Keywords

obstruction - colorectal neoplasia - stents - treatment outcome

• References

• 1 Jung KW, Won YJ, Hong S, Kong HJ, Lee ES. Prediction of cancer incidence and mortality in Korea, 2020. Cancer Res Treat 2020; 52 (02) 351-358
• 2 Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 2011; 2011 (11) CD007378
• 3 Leitman IM, Sullivan JD, Brams D, DeCosse JJ. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 1992; 174 (06) 513-518
• 4 Spinelli P, Dal Fante M, Mancini A. Self-expanding mesh stent for endoscopic palliation of rectal obstructing tumors: a preliminary report. Surg Endosc 1992; 6 (02) 72-74
• 5 Simmons DT, Baron TH. Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol 2005; 2 (08) 365-374 , quiz 1, 374
• 6 Baron TH. Expandable gastrointestinal stents. Gastroenterology 2007; 133 (05) 1407-1411
• 7 Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010; 71 (03) 560-572
• 8 Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T. et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 2004; 18 (03) 421-426
• 9 van Hooft JE, Veld JV, Arnold D. et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020; 52 (05) 389-407
• 10 Kim JY, Kim SG, Im JP, Kim JS, Jung HC. Comparison of treatment outcomes of endoscopic stenting for colonic and extracolonic malignant obstruction. Surg Endosc 2013; 27 (01) 272-277
• 11 Kuwai T, Yamaguchi T, Imagawa H. et al. Factors related to difficult self-expandable metallic stent placement for malignant colonic obstruction: a post-hoc analysis of a multicenter study across Japan. Dig Endosc 2019; 31 (01) 51-58
• 12 Kim JW, Jeong JB, Lee KL. et al. Comparison of clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent in patients with malignant colorectal obstruction. Korean J Gastroenterol 2013; 61 (01) 22-29
• 13 Geraghty J, Sarkar S, Cox T. et al. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis 2014; 16 (06) 476-483
• 14 Huang X, Lv B, Zhang S, Meng L. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 2014; 18 (03) 584-591
• 15 Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246 (01) 24-30
• 16 Manes G, de Bellis M, Fuccio L. et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg 2011; 146 (10) 1157-1162
• 17 Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99 (10) 2051-2057
• 18 Luigiano C, Ferrara F, Fabbri C. et al. Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up. Scand J Gastroenterol 2011; 46 (05) 591-596
• 19 Noronha J, deSouza A, Patil P. et al. Management of colon cancer at a tertiary referral center in India - patterns of presentation, treatment, and survival outcomes. Indian J Cancer 2019; 56 (04) 297-301