Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2015; 21(31): 9373-9379
Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9373
Colorectal stenting for palliation and as a bridge to surgery: A 5-year follow-up study
Baris Bayraktar, Ibrahim Ali Ozemir, Umut Kefeli, Gokhan Demiral, Julide Sagiroğlu, Onur Bayraktar, Gupse Adali, Alp Ozcelik, Osman Baran Tortum
Baris Bayraktar, Alp Ozcelik, General Surgery Department, Yalova Hospital, Yalova 77100, Turkey
Ibrahim Ali Ozemir, General Surgery Department, Goztepe Training and Research Hospital, Medeniyet University, Istanbul 34100, Turkey
Umut Kefeli, Medical Oncology Department, Kocaeli University Medical Faculty, Kocaeli 41112, Turkey
Gokhan Demiral, General Surgery Department, Rize Public Hospitals Association, Rize 53100, Turkey
Julide Sagiroğlu, General Surgery Department, Goztepe Training and Research Hospital, Medeniyet University, Istanbul 34100, Turkey
Onur Bayraktar, General Surgery Department, Acibadem Atakent Hospital, Istanbul 34210, Turkey
Gupse Adali, Gastroenterology Department, Corum Research and Training Hospital, Hitit University, Corum 19110, Turkey
Osman Baran Tortum, General Surgery Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul 34200, Turkey
Author contributions: All authors contributed equally in performing the literature search and analyzing results; Kefeli U, Bayraktar B and Demiral G wrote the manuscript.
Institutional review board statement: This study was reviewed and approved by the Medeniyet University Institutional Review Board.
Informed consent statement: All patients gave their verbal consent for reporting these cases.
Conflict-of-interest statement: All authors declare no conflicts of interest (including commercial, personal, political, intellectual, or religious interests).
Data sharing statement: No unpublished data were available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Baris Bayraktar, MD, General Surgery Department, Yalova Hospital, Yalova 77100, Turkey. ofbeabim@yahoo.com
Telephone: +90-533-4419046 Fax: +90-226-8137324
Received: March 10, 2015
Peer-review started: March 11, 2015
First decision: March 26, 2015
Revised: April 15, 2015
Accepted: June 10, 2015
Article in press: June 10, 2015
Published online: August 21, 2015
Processing time: 162 Days and 22.9 Hours
Abstract

AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.

METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients’ symptoms, characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate (TSR) was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate (CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery (regardless of number of SEMS deployed) to total number of patients. The surgical success rate (SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical, clinical, surgical success rates and complications after stenting were assessed.

RESULTS: The median age of patients was 64 (36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum, 15 patients in the rectosigmoid region, 10 patients in the sigmoid region, and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2 (32.7%, 16 patients) or stage 3 (42.9%, 21 patients) and 12 patients (24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery, and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo (P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies, especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical, clinical and surgical success rates were 95.9%, 100% and 94.6%, respectively.

CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition, results emphasize the importance of the skills of the endoscopist in colonic stenting.

Keywords: Large bowel obstruction; Colonic decompression; Colorectal tumors; Metallic stent; Palliative therapy

Core tip: Colorectal stents can be used for two indications in colorectal malignancies; palliative dilatation of advanced disease, and preoperative decompression as a bridge to surgery. In both indications, colonic stents prevent colostomy with stoma. Decompression of the bowel gives time for surgeons to stabilize the patient, stage the disease with imaging techniques, and take a biopsy. Thus, it allows one-stage surgery with primary anastomosis. Palliative colorectal stenting was shown to be as effective and acceptable as palliative surgery. Colonic stents showed long-term efficacy comparable to that of surgery.