Insertion of colorectal self-expanding metal stents is a safe and effective option for relieving symptoms of malignant colorectal obstruction

Background: Placement of self expanding metal stents (SEMS) has an emerging role to relieve acute colonic obstruction in otherwise operable colorectal cancer patients (pts). The aim of this retrospective study was to evaluate the efficacy and safety of colorectal SEMS insertion in pts with symptomatic malignant colonic obstruction.

Patients and methods: Between 2005 December and 2006 January, we inserted colorectal SEMS in 9 pts (mean age=79 [65–91], m/f=2/7). All pts had colorectal cancer causing significant obstruction. In 8 pts, who had non- resectable disease or were unfit for surgery, SEMS were placed for palliation of obstruction. 1 pt presenting with acute colonic obstruction, SEMS was inserted preoperatively to relieve acute obstruction caused by a tumour of the sigmoid colon. The localisations of the obstruction were the followings: rectum (4), sigmoid colon (1), splenic flexure (1), hepatic flexure (2), ascending colon (1). Technical and clinical success, complications and survival times were the endpoints of the study.

Results: SEMS were placed technically successfully in 7 pts, in the remaining two, SEMS were distally malpositioned, but functioned well, thus clinical success was 100%. As a late complication, stent migration was observed in 1 pt. Follow-up data were available for 7 pts (2 pts were lost for follow-up). At the last review (2006 January) 3 pts were alive, 4 pts died. The mean survival of pts who died was 27 (5–42) days after SEMS insertion. The only 1 patient who was treated by SEMS insertion preoperatively subsequently underwent curative resection, and recovered without any complication.

Conclusion: The use of colorectal SEMS seems to be a safe and effective non-surgical therapeutic option to relieve malignant colonic obstruction in cases of non-resectable and also in resectable tumours, if placed preoperatively.