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 | Gastroenterology | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon.  Br J Surg. 1994;81(9):1270-12767953385PubMedGoogle ScholarCrossref
Wong RW, Rappaport WD, Witzke DB, Putnam CW, Hunter GC. Factors influencing the safety of colostomy closure in the elderly.  J Surg Res. 1994;57(2):289-2928028338PubMedGoogle ScholarCrossref
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):2051-205715447772PubMedGoogle ScholarCrossref
Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents.  Br J Surg. 2002;89(9):1096-110212190673PubMedGoogle ScholarCrossref
Repici A, Fregonese D, Costamagna G,  et al.  Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study.  Gastrointest Endosc. 2007;66(5):920-92717904133PubMedGoogle ScholarCrossref
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(3):560-57220189515PubMedGoogle ScholarCrossref
Masci E, Viale E, Mangiavillano B,  et al.  Enteral self-expandable metal stent for malignant luminal obstruction of the upper and lower gastrointestinal tract: a prospective multicentric study.  J Clin Gastroenterol. 2008;42(4):389-39418277900PubMedGoogle ScholarCrossref
Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients.  Dis Colon Rectum. 1999;42(12):1569-157410613475PubMedGoogle ScholarCrossref
Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer.  Br J Surg. 2003;90(11):1429-143314598426PubMedGoogle ScholarCrossref
Tomiki Y, Watanabe T, Ishibiki Y,  et al.  Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction.  Surg Endosc. 2004;18(11):1572-157715931483PubMedGoogle Scholar
Cennamo V, Fuccio L, Mutri V,  et al.  Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy?  Clin Gastroenterol Hepatol. 2009;7(11):1174-117619631290PubMedGoogle ScholarCrossref
van Hooft JE, Fockens P, Marinelli AW,  et al; Dutch Colorectal Stent Group.  Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer.  Endoscopy. 2008;40(3):184-19118322873PubMedGoogle ScholarCrossref
Baron TH. Colonic stenting: technique, technology, and outcomes for malignant and benign disease.  Gastrointest Endosc Clin N Am. 2005;15(4):757-77116278137PubMedGoogle ScholarCrossref
Chang VT, Thaler HT, Polyak TA, Kornblith AB, Lepore JM, Portenoy RK. Quality of life and survival: the role of multidimensional symptom assessment.  Cancer. 1998;83(1):173-1799655308PubMedGoogle ScholarCrossref
Fernández-Esparrach G, Bordas JM, Giráldez MD,  et al.  Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer.  Am J Gastroenterol. 2010;105(5):1087-109319935785PubMedGoogle ScholarCrossref
Jemal A, Siegel R, Ward E,  et al.  Cancer statistics, 2008.  CA Cancer J Clin. 2008;58(2):71-9618287387PubMedGoogle ScholarCrossref
Meisner S, Hensler M, Knop FK, West F, Wille-Jørgensen P. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center.  Dis Colon Rectum. 2004;47(4):444-45014994110PubMedGoogle ScholarCrossref
Karoui M, Charachon A, Delbaldo C,  et al.  Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration.  Arch Surg. 2007;142(7):619-62317638798PubMedGoogle ScholarCrossref
Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or surgery for incurable obstructing colon cancer.  Colorectal Dis. 2008;10(7):668-67218266885PubMedGoogle ScholarCrossref
Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis.  Gastrointest Endosc. 2008;67(3):478-48818294511PubMedGoogle ScholarCrossref
Saif MW, Elfiky A, Salem RR. Gastrointestinal perforation due to bevacizumab in colorectal cancer.  Ann Surg Oncol. 2007;14(6):1860-186917356952PubMedGoogle ScholarCrossref
Cao Y, Tan A, Gao F, Liu L, Liao C, Mo Z. A meta-analysis of randomized controlled trials comparing chemotherapy plus bevacizumab with chemotherapy alone in metastatic colorectal cancer.  Int J Colorectal Dis. 2009;24(6):677-68519184059PubMedGoogle ScholarCrossref
Original Article
Oct 2011

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

Author Affiliations

Author Affiliations: Departments of Gastroenterology, University Hospital L. Sacco, Milano (Drs Manes and Ardizzone), University Hospital S. Orsola, Bologna (Drs Fuccio and Cennamo), Clinical Institute Humanitas, Rozzano, Milano (Drs Repici and Carlino), University Hospital S. Paolo, Milano (Drs Masci and Mangiavillano), and SS Trinità Hospital, Borgomanero (Dr Occhipinti); and Endoscopy Unit, National Cancer Institute and G. Pascale Foundation, Napoli (Drs de Bellis and Rossi), Italy.

Arch Surg. 2011;146(10):1157-1162. doi:10.1001/archsurg.2011.233

Objectives To evaluate the short- and long-term efficacy of self-expanding metal stents (SEMSs) in patients with colorectal obstruction and incurable cancer and the related factors that affect outcomes.

Design Retrospective analysis of SEMS placement for incurable colorectal obstruction in a 3-year period.

Setting Five tertiary care endoscopic centers.

Patients and Intervention Consecutive patients (N = 201) undergoing stenting for incurable malignant obstruction.

Main Outcome Measurements Clinical and technical success of stenting, complications rate, and factors affecting outcomes.

Results Technical success was achieved in 184 of 201 patients (91.5%) and clinical success occurred in 165 of 184 patients (89.7%; 82.1% of 201 patients). Technical and clinical failures were more frequent in extrinsic and long colorectal stenoses. Overall, 165 patients had normal bowel movements during follow-up (mean [SD], 115.5 [100.3] days; range, 1-500 days), 15 developed complications, 127 had a functioning SEMS at the time of death, and 23 were alive at completion of the study. Twenty-four (11.9%) major complications occurred: 11 migrations, 12 perforations, and 1 reobstruction. Migration of SEMSs was associated with stent diameter less than 25 mm. Bevacizumab therapy increased the risk of perforation by 19.6-fold. Karnofsky performance status of 50 or less was associated with shorter survival and a 3.7-fold higher risk of death within 6 months after the stent was placed.

Conclusions The use of SEMSs is safe and effective for palliation of incurable malignant colonic obstruction; approximately 75% of patients with SEMSs are able to avoid colostomy.