Stents in treatment of colorectal cancer – summary and personal experience

Czech version

Authors: Ľ. Žitňan ¹; J. Májek ¹; B. Pekárek ¹; P. Makovník ²
Authors‘ workplace: Národný onkologický ústav, Bratislava ¹; Onkologický ústav Sv. Alžbety, Bratislava ²
Published in: Gastroent Hepatol 2013; 67(1): 49-53
Category: Digestive Endoscopy: Review Article

Overview

Colorectal cancer is one of the diseases with the highest incidence in developed countries. This disease is still only widely diagnosed in an advanced stage, despite the introduction of screening. In some of these patients, endoscopic treatment using stents may be applicable. There are two basic indications: using stents as a bridge to radical surgical treatment; and palliative indications. Using stents as a bridge to surgery is now questionable, after initial enthusiasm surrounding the procedure. Stents have been used for a long time in palliation of malignant stenoses in the colon, and their application as a response to a correct indication has been validated by several studies. Our experience shows that stents represent suitable and effective treatment with acceptable risk of complications within the palliative management of patients with advanced disease. Particularly, these include patients with obstruction symptoms who are not good candidates for palliative surgery due to their general condition and poor survival prognosis.

Key words:
colorectal neoplasms – stents – palliative care

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
9. 10. 2012

Accepted:
5. 1. 2013

Sources

1. Cheynel N, Cortet M, Lepage C et al. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 2007; 50(10): 1568–1575.

2. Šálek T, Hlavatá Z. Systémová terapia karcinómu konečníka a hrubého čreva. In Bolješíková E, Májek J, Makovník P et al. Gastrointestinálna onkológia. Infoma 2008: 136–142.

3. Pirlet IA, Slim K, Kwiatkowski F et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2011; 25(6): 1814–1821.

4. van Hooft JE, Bemelman WA, Oldenburg B et al. Colonic stenting versus emergency surgery for acute left sided malignantcolonic obstruction: a multicentre randomized trial. Lancet Oncol 2011; 12(4): 344–352.

5. Sebastain S, Johnston S, Georghegan T et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99(10): 2051–2057.

6. Baron TH. Colonic Stenting: a palliative measure only or a bridge to surgery? Endoscopy 2010; 42(2): 163–168.

7. van Hooft JE, Fockens P, Marinelli AW et al. Early closure of multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 2008; 40(3): 184–191.

8. Faragher IG, Chaitowitz IM, Stupart DA. Long term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis 2008; 10(7): 668–672.

9. Lopera JE, De Gregario MA. Flouroscopic management of complication after Colorectal Stent placement. Gut Liver 2010; 4 (Suppl 1): S9–18.

10. Small AJ, Baron TH. Comparison of Wallstent and Ultraflex Stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc 2008; 67(3): 478–488.

11. Lee KM, Shin SJ, Hwang JC et al. Comparison Of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc 2007; 66(5): 931–936.

12. Jung MK, Park SY, Jeon SW et. al. Factors associated with the long term outcome of a self-expandable colon stent used for palliation of malignant large bowel obstruction. Surg Endosc 2010; 24(3): 525–530.

13. Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of selfexpandable metal stents for malignant colonic obstruction:long-term outcomes and complication factors. Gastrointest Endosc 2010; 71(3): 560–572.

14. Cennamo V, Fuccio L, Mutri V et al. Does stent placement for advanced colon cancer increse the risk of perforation during bevacizumab based therapy? Clin Gastroenterol Hepatol 2009; 7(11): 1174–1176.

15. Binkert CA, Ledermann H, Jost R et al. Acute colonic obstruction: clinical aspects and cost-effektivenessof preoperative and palliative treatment with self-expanding metallic stents – a prelimenary report. Radiology 1998; 206(1): 199–204.