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28-09-2011 | Surgery | Article

Metallic stent clinically effective for colonic obstruction in cancer patients


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MedWire News: Technical and clinical success rates are similar among patients with primary colorectal cancer and extracolonic malignancies after palliative endoscopic stent placement for colorectal obstruction, report researchers.

The finding is in contrast to the researchers' hypothesis that outcomes of stent placement may be different among colorectal and extracolonic malignancies owing to differences in tumor behavior.

"In contrast to colonic malignancy, colonic obstructions in patients with extracolonic malignancies are due to secondary involvement of the colon," say Ho-Young Song from the University of Ulsan College of Medicine in Seoul, Republic of Korea, and colleagues.

However, they report that rates of perforation, stent migration, tumor overgrowth, bleeding, and pain "did not differ significantly" between the two types of cancer patient that took part in their study.

The team reviewed data for 108 cancer patients who received palliative stent placement for inoperable malignant colonic obstruction between 2001 and 2010. In all, 58 patients had primary colorectal cancer, and 50 had extracolonic malignancies including gastric, esophageal, pancreatic, ovarian, bladder, and breast cancers.

Patients underwent a barium study 1-3 days after stent placement, and again 1 month later, to evaluate the stent expansion and patency, and any possible complications.

Technical success was defined as correct placement of the stent within the stricture, and clinical success was defined as colonic decompression and relief of obstructive symptoms, explain Song and co-authors in the Journal of Vascular and Interventional Radiology.

Stent placement was technically successful in 96 (86%) patients, 49 (84%) of those with a colorectal malignancy, and 47 (94%) of those with extracolonic malignancies. The 12 patients whose stent placement failed all underwent palliative surgery.

A total of 48 (98%) colorectal patients and 45 (96%) extracolonic malignancy patients experienced clinical success, and among all patients with technical success, 93 (97%) had complete (n=88) or partial (n=5) colonic decompression, and relief of obstructive symptoms.

Colonic perforation occurred a mean 2 months after stent placement in five (11%) patients with extracolonic malignancies and in one patient (2%) with primary colorectal cancer; a nonsignificant difference. No clinical factors (such as location of stricture, previous surgery, or chemotherapy) had any significant association with likelihood of perforation.

Five (10%) colorectal cancer patients and two (4%) extracolonic cancer patients experienced stent migration after a mean 5 months, and again, there were no significant associations between migration and any clinical parameters studied.

All bleeding episodes (three colorectal patients, four extracolonic) resolved spontaneously, report the researchers, four patients experienced tumor overgrowth after a mean 6.0 months, and the overall median survival was 4.6 months and 4.1 months in the colorectal and extracolonic cancer groups, respectively. None of these differences were significant.

The researchers conclude that to confirm their findings, "further studies evaluating success and complication rates after colonic stent placement according to the specific types of extracolonic malignancy are required."

By Sarah Guy

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