TY - JOUR
T1 - Self-expandable metal stents (SEMS) can serve as a bridge to surgery or as a definitive therapy in patients with an advanced stage of cancer
T2 - Clinical experience of a tertiary cancer center
AU - Lee, Jeffrey H.
AU - Ross, William A.
AU - Davila, Raquel
AU - Chang, George
AU - Lin, E.
AU - Dekovich, Alexander
AU - Davila, Marta
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2010/12
Y1 - 2010/12
N2 - Background: Self-expandable metal stents (SEMS) can be used to relieve benign and malignant colorectal obstruction. Aims: The aim of this study was to determine the outcomes of SEMS for malignant colorectal obstruction. Methods: Retrospective review was done of patients who underwent endoscopic SEMS placement from 2001 to 2007. Results: Forty-six patients (23 M), mean age 60 years (range 24-82) underwent endoscopic SEMS placement. Cancer types included: 28 colorectal, and 18 metastatic cancers. The locations of the obstruction were as follows: two in the ascending colon, one in the hepatic flexure, three in the transverse colon, two in the splenic flexure, two in the descending colon, 26 in the sigmoid colon, and ten in the rectum. In 39 of the 46 cases (84.8%), placement of a single SEMS was successful covering the entire strictures, but in seven cases, two of the stents were placed in tandem resulting in adequate overage of stricture. Technical success was achieved in all cases. Clinical success was achieved in 39 out of 46 cases (84.8%). Two perforations were detected immediately and day 5 after SEMS placement, resulting in one death and one emergent surgery. Mean follow-up was 126 days (range 2-1,210). Twenty-eight of the 46 patients (61%) died during the follow-up period with the median overall survival being 3.52 months (95% CI: 2.34-4.41 months). Conclusions: Placement of SEMS for the treatment of colorectal obstruction is feasible and safe. In our institution, where SEMS are primarily used to palliate terminal disease, technical and clinical success rates were high without significant morbidity and mortality. On long-term follow-up, patients died from their advanced disease with infrequent recurrent obstruction or stent-related complications.
AB - Background: Self-expandable metal stents (SEMS) can be used to relieve benign and malignant colorectal obstruction. Aims: The aim of this study was to determine the outcomes of SEMS for malignant colorectal obstruction. Methods: Retrospective review was done of patients who underwent endoscopic SEMS placement from 2001 to 2007. Results: Forty-six patients (23 M), mean age 60 years (range 24-82) underwent endoscopic SEMS placement. Cancer types included: 28 colorectal, and 18 metastatic cancers. The locations of the obstruction were as follows: two in the ascending colon, one in the hepatic flexure, three in the transverse colon, two in the splenic flexure, two in the descending colon, 26 in the sigmoid colon, and ten in the rectum. In 39 of the 46 cases (84.8%), placement of a single SEMS was successful covering the entire strictures, but in seven cases, two of the stents were placed in tandem resulting in adequate overage of stricture. Technical success was achieved in all cases. Clinical success was achieved in 39 out of 46 cases (84.8%). Two perforations were detected immediately and day 5 after SEMS placement, resulting in one death and one emergent surgery. Mean follow-up was 126 days (range 2-1,210). Twenty-eight of the 46 patients (61%) died during the follow-up period with the median overall survival being 3.52 months (95% CI: 2.34-4.41 months). Conclusions: Placement of SEMS for the treatment of colorectal obstruction is feasible and safe. In our institution, where SEMS are primarily used to palliate terminal disease, technical and clinical success rates were high without significant morbidity and mortality. On long-term follow-up, patients died from their advanced disease with infrequent recurrent obstruction or stent-related complications.
KW - Bridging to surgery
KW - Malignant colonic obstruction
KW - Metal stent
KW - Palliation
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U2 - 10.1007/s10620-010-1370-7
DO - 10.1007/s10620-010-1370-7
M3 - Article
C2 - 20721627
AN - SCOPUS:78649284765
SN - 0163-2116
VL - 55
SP - 3530
EP - 3536
JO - Digestive diseases and sciences
JF - Digestive diseases and sciences
IS - 12
ER -