Palliative large-bowel decompression for colorectal obstruction in patients with unresectable locally advanced cancer and carcinomatosis

Davydova S.V.; Fedorov A.G.; Yun O.A.; Klimov A.E.

doi:https://doi.org/10.17116/endoskop20243003121

Davydova S.V.

Peoples’ Friendship University

ORCID: 0000-0002-4979-0264

Fedorov A.G.

Peoples’ Friendship University

ORCID: 0000-0002-4562-9481

Yun O.A.

Buyanov Moscow City Clinical Hospital

ORCID: 0000-0002-4548-7321

Klimov A.E.

Peoples’ Friendship University

ORCID: 0000-0002-1397-9540

Palliative large-bowel decompression for colorectal obstruction in patients with unresectable locally advanced cancer and carcinomatosis

Authors:

Davydova S.V., Fedorov A.G., Yun O.A., Klimov A.E.

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Journal: Endoscopic Surgery. 2024;30(3): 21‑28

DOI: 10.17116/endoskop20243003121

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To cite this article:

Davydova SV, Fedorov AG, Yun OA, Klimov AE. Palliative large-bowel decompression for colorectal obstruction in patients with unresectable locally advanced cancer and carcinomatosis. Endoscopic Surgery. 2024;30(3):21‑28. (In Russ.)
https://doi.org/10.17116/endoskop20243003121

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

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OBJECTIVE

Evaluation clinical outcomes of stenting and decompressive surgery in patients with colorectal obstruction due to unresectable locally advanced cancer and carcinomatosis.

MATERIAL AND METHODS

A retrospective analysis of palliative treatment of 73 patients with large-bowel obstruction was performed. Criterion of inclusion — presence of unresectable primary, recurrent or metastatic locally advanced tumour with invasion to adjacent tissues and/or peritoneal dissemination. Patients underwent colorectal stenting (39) or decompressive surgery (34) (loop colostomy — 29, ileotransverse bypass — 5). Left-sided obstruction was observed in 64 (35/29) patients, right-sided — in 9 (4/5) patients. Location of tumour: colorectal cancer — 57 (29/28), extracolonic tumour — 16 (10/6) patients.

RESULTS

Complications occurred in 3 patients (7.7%) after stenting and in 11 (32.4%) after surgical palliation (p=0.0083) with post-procedure mortality 5.1% (2 patients) vs. 14.7% (5 patients), p=0.2675. Stoma complications and wound infection prevailed among surgical adverse events; all stent-related complications included bowel perforation. General adverse events were observed in 5 patients after colostomy vs. 0 after stenting (p=0.0185). Hospital stay was shorter for stenting (p=0.0010).

CONCLUSION

Stenting and loop colostomy or bypass appear to be equally effective for management of large bowel obstruction in patients with locally advanced unresectable cancer of various etiology, including extracolonic, recurrent and metastatic tumours. In comparison to decompressive surgery colorectal stenting is less invasive, has an advantage of fewer adverse events, shorter hospital stay, absence of stoma and therefore may be recommended as a final palliation.

Keywords:

colorectal stenting

self-expandable stents

SEMS

colorectal cancer

large-bowel obstruction

colostomy

Authors:

Davydova S.V.

Peoples’ Friendship University

ORCID: 0000-0002-4979-0264

Fedorov A.G.

Peoples’ Friendship University

ORCID: 0000-0002-4562-9481

Yun O.A.

Buyanov Moscow City Clinical Hospital

ORCID: 0000-0002-4548-7321

Klimov A.E.

Peoples’ Friendship University

ORCID: 0000-0002-1397-9540

Received:

23.06.2023

Accepted:

01.08.2023

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References:

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