Introduction Colonic self-expanding metallic stents (SEMS) may provide prompt relief of acute malignant colorectal obstruction (AMCO) and are increasingly used either palliatively or as a bridge to surgery (BTS) in patients in whom a definitive surgical approach is unsuitable. We evaluated short-term outcomes of malignant colorectal obstructive patients treated with SEMS in our institution over a 3-year period.
Methods A prospectively maintained database was reviewed to identify all patients who presented to our institution with AMCO between August 2010 and 2013 and who were treated with a SEMS either temporarily or permanently. Additional data was retrieved from chart and pathology reviews. A single colorectal surgeon inserted all stents under both endoscopic and fluoroscopic guidance. Data was analysed using SPSSv21 (SPSS Inc., Chicago, IL, USA) and presented as median (interquartile range). Continuous variables were assessed using analysis of variance. A p value <0.05 was considered statistically significant.
Results Sixteen patients each had a single stent inserted during the study period, either palliatively (n = 11) or as a BTS (n = 5). Their median (IQR) age was 75 (21) years and 12 (75%) patients were males. Most tumours were located in the sigmoid colon (6/16, 37%). The technical and clinical success rates were both 87.5% (14/16) and there were no SEMS-related perforations. The two unsuccessful stenting cases both had metastatic disease and required emergency surgery while five patients with potentially curable disease proceeded to elective resections. There was no procedure-related mortality. There was no difference in the median length of stay (LOS) post SEMS insertion in the palliative group compared to the BTS group [4 (4) vs. 5 (3), p = 0.2]. However, the median (IQR) LOS post acute surgery was longer than elective surgery [45 (30) vs. 14 (8) days, p = 0.018]. All patients in the BTS group were stoma-free post-operatively, while both patients who had emergency surgery ended up with permanent stomas. Finally, the stent complication rate was 6.2% (1/16), secondary to migration in a patient who was stented palliatively. The latter patient did not undergo further attempted stenting as his obstructive symptoms had been alleviated.
Conclusion AMCO poses significant challenges in management due to the frailty of the presenting patients and the high morbidity/mortality rates associated with emergency surgery. Although limited by a small sample size, our study shows that SEMS are a favourable alternative to emergency surgery for the management of AMCO. Further larger scale studies looking at long-term survival and oncological outcomes are awaited.
Disclosure of Interest None Declared.