Abstract

CASTANO LLANO, Rodrigo et al. Comparative Study of Colonic Stenting against Laparotomy for Treating Acute Intestinal Obstruction Due to Colorectal Cancer. Rev Col Gastroenterol [online]. 2015, vol.30, n.1, pp.32-45. ISSN 0120-9957.

Objective: Obstructions due to colorectal cancer (CRC) are common and carry significant risks of morbidity and mortality. The use of colonic stents appears to be a good alternative and can be used with palliative therapy or as a bridge to facilitate definitive one-time-only surgery. The aim of this study is to compare the use of stents with surgery in patients with malignant colorectal obstructions in terms of morbidity, survival and the need for ostomies. Methods: This is a descriptive study based on data collected from a cohort of 103 patients from 2004 to 2012. Data were recorded in a database designed for this purpose. Patients were retrospectively divided into four groups for purposes of analysis. One group, which was labelled SCX, had had colonic stents placed and later underwent elective surgery (n = 26). A second group labelled CXC had undergone conventional surgery (n = 30). The other two groups consisted of patients in advanced stages of the disease. One of these groups, labelled SP received palliative stents (n = 24). The final group, labelled CP, underwent palliative surgery (n = 23). Comparisons among groups were made and then descriptions of the most important findings were developed. Results: The technical success rate was 90.0% and the clinical success rate was 82.0% in the groups of patients who received stents. There were two perforations in the SP group (8.3%) and none in the other group (SP) which received stents.  Stent migration occurred in three patients (11.5%) in the SCX group and three (12.5%) in the SP group. The overall survival rate was 42.7%, but was only 4.2% in the SP group and 34.8% in the CP group. Fewer ostomies were required in the SCX group (five patients, 19.2%) than in the CXC group (eight patients, 26.7%) although the difference was not statistically significant. Similarly eight patients (26.7%) in the CXC group and 15 patients (65.2%) in the CP group required ostomies (P <0.05). Obstructions were relieved in 22 patients (84.6%) in the SCX group, but in only 18 patients (60%) in the CXC group which is a statistically significant difference (P = 0.042). The hospital average stay of 4 days (0-9 days) for the groups managed with stents (SCX and SP) was shorter than for the other two groups. Thirty patients required at least one reoperation in the CXC group, nine (39.1%) in the CP group and 8 in the group that received stents. Conclusions: The use of colorectal stents for palliative or preoperative bridge therapy has low morbidity, and sometimes avoids temporary or permanent colostomies. Surgery and the use of ostomies can be avoided in patients with advanced disease who are undergoing palliative care, plus they have shorter hospital stays. However, prospective studies to clarify what the true role of stents in malignant colorectal obstructive disease are still needed

Keywords : Colorectal cancer; acute colorectal obstruction; prosthetics.

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