A team from the Creighton University School of Medicine, Omaha, Nebraska, USA assessed the use of self-expanding metallic stents (SEMS) in the management of obstructing colorectal cancer.
A retrospective chart review of all patients undergoing placement of SEMS between May 1997 and January 2000 was performed.
The researchers attempted insertion of SEMS in 12 patients. Successful stent placement was achieved in 10 of the patients.
The locations of lesions were hepatic flexure (2), splenic flexure (1), left colon (1), sigmoid colon (4) and rectum (4).
The intended uses of SEMS were for palliation in 3 patients and as a bridge to elective surgery in 9.
As a palliative measure, self-expanding metallic stents can eliminate the need for an operation.
|Dr H. Liberman.
In the latter group, SEMS placement allowed for preoperative bowel preparation in 4 patients and administration of neoadjuvant therapy prior to elective surgery in 2 patients.
1 patient died prior to definitive surgery and stent placement was unsuccessful in 2 patients.
3 SEMS-related complications occurred; 1 stent migrated and 1 stent obstructed secondary to tumor ingrowth.
In addition, 1 patient died 13 days after stent placement and colonic decompression.
Researcher H. Liberman said on behalf of the group, "SEMS represent a useful tool in the management of obstructing colorectal neoplasms. As a bridge to surgery, SEMS provide time for a complete preoperative evaluation and a mechanical bowel preparation, and may obviate the need for fecal diversion or on-table lavage. It may also allow for time to administer neoadjuvant therapy when indicated."
"As a palliative measure, SEMS can eliminate the need for an operation," it was concluded.