Efficacy of uncovered self-expandable metallic stent for colorectal obstruction by extracolonic malignancy

BACKGROUND Self-expandable metallic stent(SEMS)is widely used for malignant colorectal obstruction.Recently,SEMS has been used for palliative option for colorectal obstruction caused by extracolonic malignancy(ECM).AIM To evaluate the efficacy of SEMS for colorectal obstruction caused by ECM,and to identify the factors associated with stent occlusion.METHODS Seventy-two patients who were treated with uncovered SEMS insertion for malignant colorectal obstructions caused by colorectal metastasis or peritoneal seeding of ECM at Samsung Medical Center between April 2012 to March 2016 were enrolled.We analyzed technical and clinical outcomes of stent insertion,the factors associated with stent occlusion and long term outcomes after stent insertion.RESULTS Technical success rate was determined as 90.3%with a clinical success rate of 87.7%.Stent occlusion developed in 28.1%,with a median duration of 51 d.Further,81.3%with stent occlusion could be treated with secondary stent insertion.Clinical failure was observed to be related to the male sex(P=0.020)and right colon obstruction(P=0.017).Stent length≤10 cm was found to be associated with stent occlusion(P=0.003).Median survival time after stent insertion was 4.7 mo and 40.4%were able to receive their oncological treatments after stent insertion without surgery.CONCLUSION Uncovered SEMS is effective for the treatment of colorectal obstruction caused by ECM,considering life expectancy of patients with ECM.

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction:A review of the literature after 2020

It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.