Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7138
Revised: July 22, 2013
Accepted: August 4, 2013
Published online: November 7, 2013
Processing time: 217 Days and 1.5 Hours
AIM: To investigate whether predicting patients that might be at a higher risk for complications might serve to improve the selection of patients undergoing colonic stenting.
METHODS: A retrospective review of consecutive patients who underwent an attempted self-expandable metal stent (SEMS) insertion for malignant colonic obstruction between November 2006 and March 2013. All patients were either referred for preoperative colonic decompression with the intent of a single surgical procedure, or for palliation of the malignant colorectal obstruction for unresectable cancer. Fisher’s test or χ2 test was performed on categorical variables, and the t test for continuous variables. Univariable and multivariable logistic regression were used to examine the association between independent variables and the presence of complications from SEMS insertion.
RESULTS: SEMS insertion was attempted in 73 patients. Males comprised 55.71% and the mean age was 67.41 ± 12.41 years. Of these, 65.15% underwent subsequent surgery, while 34.85% received SEMS as palliation for advanced disease. Extracolonic tumors were only 4.76%. The majority of patients had stage IV disease (63.83%), while the remainder had stage III (36.17%). SEMS were successfully inserted in 93.85% (95%CI: 87.85%-99.85%). Perforations occurred in 4.10%, SEMS migration in 8.21%, and stent re-occlusion from ingrowth occurred in 2.74% of patients. The mean duration of follow up for the patients was 13.52 ± 17.48 mo (range 0-73 mo). None of the variables: age, sex, time between the onset of symptoms to SEMS insertion, time between SEMS insertion and surgery, length of the stenosis, location of the stenosis, albumin level, or receiving neoadjuvant chemotherapy, could predict the development of complications from either SEMS insertion nor prolonged survival.
CONCLUSION: None of the variables could predict the development of complications or survival. Further studies are required to identify patients who would benefit the most from SEMS.
Core tip: Despite the debate as to whether there is an added benefit from the use of self-expandable metal stents (SEMS), when compared to surgery, as an initial management strategy in patients with malignant colorectal obstruction, this study found that SEMS insertion for malignant colonic obstruction is a safe option with an acceptable risk profile. We could not identify factors that would predict the development of complications or factors that might impact long-term survival. Nonetheless, based on current guidelines, SEMS insertion for malignant colorectal obstruction is the best option for palliation or as a bridge to surgery when technical skills for such a procedure are available.