Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2020; 12(9): 1005-1013
Published online Sep 15, 2020. doi: 10.4251/wjgo.v12.i9.1005
Efficacy of uncovered self-expandable metallic stent for colorectal obstruction by extracolonic malignancy
Joon Seong Ahn, Sung Noh Hong, Dong Kyung Chang, Young-Ho Kim, Eun-Ran Kim
Joon Seong Ahn, Sung Noh Hong, Dong Kyung Chang, Young-Ho Kim, Eun-Ran Kim, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Author contributions: Kim ER designed research, Ahn JS and Kim ER carried out the acquisition, analysis, interpretation of data, writing and drafting of the manuscript; Hong SN, Chang DK, Kim YH did the critical revision of the manuscript for important intellectual content. All authors approved the final submission
Institutional review board statement: This study was reviewed and approved by the Institutinal Review Board of Samsung Medical Center (No.2017-01-009).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eun-Ran Kim, MD, PhD, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. er.kim@samsung.com
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: June 15, 2020
Revised: July 5, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 15, 2020
Processing time: 97 Days and 22.2 Hours
Abstract
BACKGROUND

Self-expandable metallic stent (SEMS) is widely used for malignant colorectal obstruction. Recently, SEMS has been used for palliative option for colorectal obstruction caused by extracolonic malignancy (ECM).

AIM

To evaluate the efficacy of SEMS for colorectal obstruction caused by ECM, and to identify the factors associated with stent occlusion.

METHODS

Seventy-two patients who were treated with uncovered SEMS insertion for malignant colorectal obstructions caused by colorectal metastasis or peritoneal seeding of ECM at Samsung Medical Center between April 2012 to March 2016 were enrolled. We analyzed technical and clinical outcomes of stent insertion, the factors associated with stent occlusion and long term outcomes after stent insertion.

RESULTS

Technical success rate was determined as 90.3% with a clinical success rate of 87.7%. Stent occlusion developed in 28.1%, with a median duration of 51 d. Further, 81.3% with stent occlusion could be treated with secondary stent insertion. Clinical failure was observed to be related to the male sex (P = 0.020) and right colon obstruction (P = 0.017). Stent length ≤ 10 cm was found to be associated with stent occlusion (P = 0.003). Median survival time after stent insertion was 4.7 mo and 40.4% were able to receive their oncological treatments after stent insertion without surgery.

CONCLUSION

Uncovered SEMS is effective for the treatment of colorectal obstruction caused by ECM, considering life expectancy of patients with ECM.

Keywords: Self-expandable metallic stent; Colorectal stent; Colorectal obstruction; Extracolonic malignancy; Retrospective study

Core Tip: This is a single center, retrospective study to evaluate the efficacy of the insertion of self-expandable metallic stent (SEMS) for palliative option for colorectal obstructions by extracolonic malignancy (ECM). Seventy-two patients who were diagnosed with colorectal obstruction by ECM and treated with SEMS were enrolled. Technical success rate was determined as 90.3% with a clinical success rate of 87.7%. We also evaluated factors associated with clinical failure and long-term outcomes after SEMS insertion. Palliative treatment using uncovered SEMS insertion for colorectal obstruction caused by ECM was found to be as effective and safe treatment approach, considering life expectancy of patients with ECM.