Original ArticlesUse of self-expanding metal stents for palliation of rectosigmoid cancer☆
Section snippets
Patients and methods
From November 1990 to February 1999, 37 patients (mean age, 76 years; range 39-95; 19 men) with stenosing rectal or rectosigmoid cancer were treated by endoscopic insertion of self-expanding metal stents in a prospective series. Inclusion criteria were the presence of primary or recurrent malignant rectal or rectosigmoid stenosis in patients deemed unfit for surgery because of local extension, metastatic disease, or high surgical risk. Exclusion criteria were the presence of rectal stenosis
Results
Metal stents were placed correctly in 36 of the 37 patients (97%). In the first patient to undergo the procedure, the metal stent was placed partially proximal to the lesion. During endoscopic removal of the stent with a polypectomy snare, metallic mesh was damaged. Two patients had stenoses that were 9 cm long and required placement of 2 stents in series.
All patients tolerated the procedure well and no complication was observed within 24 hours of stent placement. The only early complications
Discussion
Although surgery provides excellent palliation for patients with obstructing rectosigmoid cancer, the surgical mortality rate is as high as 17% and there is no evidence that palliative resections prolong survival.16 Furthermore, the presence of a colostomy decreases the quality of life.17 Hence many patients refuse colostomy and request alternative noninvasive treatments that maintain bowel continuity and continence.
The reported success of various palliative endoscopic and other nonsurgical
References (23)
- et al.
Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes
Gastrointest Endosc
(1998) - et al.
Cancer of the rectum - palliative endoscopic treatment
Eur J Surg Oncol
(1995) - et al.
Dose response relationship for radiation therapy of recurrent, residual and primarily inoperable colorectal cancer
Radiother Oncol
(1984) - et al.
Endoscopic alternatives in the management of colonic strictures
Surgery
(1990) - et al.
Endoscopic treatment of gastrointestinal tumors: indications and results of laser photocoagulation and photodynamic therapy
Semin Surg Oncol
(1995) - et al.
Palliative and curative electrocoagulation for rectal cancer
Cancer
(1985) - et al.
Results of cryosurgery in the treatment of inoperable tumor stenoses of the anus and rectum
Zentralbl Chir
(1991) - et al.
Photodynamic therapy for colorectal disease
Int J Colorect Dis
(1989) - et al.
Self-expanding mesh stent for endoscopic palliation of rectal obstructing tumors: a preliminary report
Surg Endosc
(1992) - et al.
Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients
Endoscopy
(1995)
Stent endoprosthesis for obstructing colorectal cancers
Dis Colon Rectum
Cited by (65)
Cancer of the Rectum
2019, Abeloff’s Clinical OncologyColonoscopy and flexible sigmoidoscopy
2013, Colorectal Surgery, Fifth EditionSurgical Management of Colon Cancer
2012, Colorectal SurgeryUltraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study
2007, Gastrointestinal EndoscopyCitation Excerpt :The colonic nitinol SEMS was successfully deployed in 95% of patients. This rate of technical success is consistent with that reported for previous prospective clinical trials of SEMS for palliation (Table 3).13,19-24 As with all procedures, there is a learning curve, and, in 2 cases, the stent was not properly deployed initially, but a second attempt successfully decompressed the bowel.
Acute Colonic Obstruction
2007, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :It is extremely helpful to have nursing assistants who are facile in complex therapeutic endoscopic procedures and SEMS placement assist with these procedures. For distal left-sided lesions, some authors prefer to assess the entire lesion entirely under endoscopic guidance [17]. If the endoscope cannot be passed through the lesion, the stricture is balloon dilated cautiously using TTS balloons of 12 to 15 mm diameters.
Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos) {A figure is presented}
2006, Gastrointestinal EndoscopyCitation Excerpt :There were another 25 less severe complications (14%), which were managed conservatively or by endoscopic reintervention. The usefulness of SEMS to palliate MCRO has been previously shown in several series,3-9 each time with a higher number of procedures (Table 414-21). These reports come from single centers, which may have special dedication and interest in this intervention.
- ☆
Reprint requests: Pasquale Spinelli, MD, Divisione di Diagnostica e Chirurgia Endoscopica, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy.