Colorectal stenting for palliation and as a bridge to surgery: A 5-year follow-up study

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 overa