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PTH-001 “Prophylactic” placement of self-expandable metal stent in colorectal cancer prior to obstruction: is this of any value?
  1. S K Butt,
  2. K Jaggs,
  3. N Van Someren,
  4. K Besherdas
  1. Department of Gastroenterology, Chase Farm Hospital, Enfield, UK

Abstract

Introduction Colorectal cancer (CRC) is one of the most prevalent malignancies in the world and is the second most common cancer cause of death in the UK. Colonic obstruction is usually a late presentation of CRC and is more characteristic of an advanced and incurable lesion. 40% of CRC present as a surgical emergency with either obstruction or perforation. Emergency presentation is associated with a poorer outcome. Colonic stents are a routine part of management of CRC, being used for palliation and as a “bridge to surgery“ for patients presenting with bowel obstruction thus minimising morbidity and mortality. It can be argued that the tighter the CRC stricture the more difficult the process of placement of colonic stent. For this reason, it has been suggested by some that “prophylactic” stent placement in the palliation of CRC patients who have stricturing but not yet obstruction may be an appropriate step in management. This may reduce failure rate of stent placement during obstruction and thus prevent emergency surgical decompression.

Methods To aim was to assess the number of patients presenting with a stricturing CRC tumour that subsequently obstructs.

This was a retrospective analysis was performed on consecutive patients with CRC during 2006–2007, presenting with a stricture as identified on colonoscopy and deemed for palliation following a multidisciplinary assessment. An analysis of whether or not these patients subsequently developed obstruction was performed. Data were obtained from the Unisoft endoscopy software and a database of patients with CRC.

Results 17 patients (9 males, mean age of 78 (52 to 96 years)), were found to have a malignant stricturing lesion at colonoscopy and had palliative treatment. Four patients presented with obstruction as part of their symptom complex and underwent successful colonic stent placement. One patient underwent a defunctioning stoma operation for bowel obstruction 1 month following diagnosis. In the 12 cases (70%) that were not stented, none re-presented with bowel obstruction. 16 /17 patients died from causes unrelated to bowel obstruction, with all dying within 18 months due to disease progression and chemotherapy related complications. One patient who initially presented with obstructive symptoms and was subsequently stented is still alive to date.

Conclusion The majority (70%) of CRC presenting with stricturing at colonoscopy do not require treatment for obstruction (ie, stenting or operation) and seem to die from disease progression prior to occurrence of clinical obstruction. “Prophylactic” stent placement to prevent obstruction, when CRC presents with a stricturing lesion is not suggested by this study.

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