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

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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

List of references:

Van Hooft J, Veld J, Arnold D, Beets-Tan R, Everett S, Götz M, Van Halsema E, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis P, Vanbiervliet G, Arezzo A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline — Update 2020. Endoscopy. 2020;52:389-407. https://doi.org/10.1055/a-1140-3017
Zhao X, Cai B, Cao R, Shi R. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol. 2013;19(33):5565-5574. https://doi.org/10.3748/wjg.v19.i33.5565
Liang T, Sun Y, Wei Y, Yang D. Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis. Surg Today. 2014;44(1):22-33. https://doi.org/10.1007/s00595-013-0665-7
Takahashi H, Okabayashi K, Tsuruta M, Hasegawa H, Yahagi M, Kitagawa Y. Self-expanding metallic stents versus surgical intervention as palliative therapy for obstructive colorectal cancer: a meta-analysis. World J Surg. 2015;39(8):2037-2044. https://doi.org/10.1007/s00268-015-3068-7
Ribeiro I, Bernardo W, Martins B, De Moura D, Baba E, Josino I, Miyajima N, Cordero MC, Visconti T, Ide E, Sakai P, De Moura E. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open. 2018;06:E558-E567. https://doi.org/10.1055/a-0591-2883
Fiori E, Lamazza A, Schillaci A, Femia S, Demasi E, Decesare A, Sterpetti AV. Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. Am J Surg. 2012;204(3):321-326. https://doi.org/10.1016/j.amjsurg.2011.11.013
Young CJ, De-Loyde KJ, Young JM, Solomon MJ, Chew EH, Byrne CM, Salkeld G, Faragher IG. Improving quality of life for people with incurable large-bowel obstruction: randomized control trial of colonic stent insertion. Dis Colon Rectum. 2015;58(9):838-849. https://doi.org/10.1097/dcr.0000000000000431
Young CJ, Zahid A. Randomized controlled trial of colonic stent insertion in non-curable large bowel obstruction: a post hoc cost analysis. Colorectal Dis. 2018;20(4):288-295. https://doi.org/10.1111/codi.13951
Abelson JS, Yeo HL, Mao J, Milsom JW, Sedrakyan A. Long-term postprocedural outcomes of palliative emergency stenting vs stoma in malignant large-bowel obstruction. JAMA Surgery. 2017;152(5):429-435. https://doi.org/10.1001/jamasurg.2016.5043
Bagateliya ZA, Gugnin AV, Lebedev SS, Grekov DN, Korzheva IYu. Analysis of the results of palliative treatment of patients with colorectal cancer complicated by intestinal obstruction. Moskovskii khirurgicheskii zhurnal. 2018;5(63):55-61. (In Russ.). https://doi.org/10.17238/issn2072-3180.2018.5.55-61
Bokarev MI, Vodoleev AS, Mamykin AI, Muntyanu EV, Duvansky VA, Demyanov AI, Belov YuV. Effectiveness of various approaches for acute malignant colonic obstruction. Pirogov Russian Journal of Surgery. 2018;10:55-60. (In Russ.). https://doi.org/10.17116/hirurgia201810155
Abbas MA, Kharabadze G, Ross EM, Abbass MA. Predictors of outcome for endoscopic colorectal stenting: a decade experience. Int J Colorectal Dis. 2017;32(3):375-382. https://doi.org/10.1007/s00384-016-2696-1
Faraz S, Salem SB, Schattner M, Mendelsohn R, Markowitz A, Ludwig E, Zheng J, Gerdes H, Shah PM. Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy. Gastrointest Endosc. 2018;87(5):1310-1317. https://doi.org/10.1016/j.gie.2017.12.017
Kuwai T, Yamaguchi T, Imagawa H, Yoshida S, Isayama H, Matsuzawa T, Yamada T, Saito S, Shimada M, Hirata N, Sasaki T, Koizumi K, Maetani I, Saida Y. Factors related to difficult self-expandable metallic stent placement for malignant colonic obstruction: A post-hoc analysis of a multicenter study across Japan. Digest Endosc. 2019;31(1):51-58. https://doi.org/10.1111/den.13260
Park YE, Park Y, Park SJ, Cheon JH, Kim WH, Kim TI. Outcomes of stent insertion and mortality in obstructive stage IV colorectal cancer patients through 10 year duration. Surg Endosc. 2019;33(4):1225-1234. https://doi.org/10.1007/s00464-018-6399-2
Han B, Hong JY, Myung E, Oh HH, Yang HC, Kim SW, Lee J, Kim SJ, Han YD, Seo GS, Hong GY, Kim HD, Kim HS, Joo YE. Predictors of clinical outcomes of self-expandable metal stent treatment for malignant colorectal obstruction: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study. Medicine (Baltimore). 2021;100(27):e26616. https://doi.org/10.1097/md.0000000000026616
Kwon SJ, Yoon J, Oh EH, Kim J, Ham NS, Hwang SW, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Yang DH. Factors associated with clinical outcomes of palliative stenting for malignant colonic obstruction. Gut Liver. 2021;15(4):579-587. https://doi.org/10.5009/gnl20145
Kim BK, Hong SP, Heo HM, Kim JY, Hur H, Lee KY, Cheon JH, Kim TI, Kim WH. Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. Gastrointest Endosc. 2012;75(2):294-301. https://doi.org/10.1016/j.gie.2011.09.026
Yurichev IN, Karasev IA, Vereschak VV, Burdyukov MS, Malikhova OA, Malikhov AG. Colorectal stenting in cancer patients. Oncologicheskaya koloproktologiya. 2018;8(2):55-62. (In Russ.). https://doi.org/10.17650/2220-3478-2018-8-2-55-62
Weston BR, Patel JM, Pande M, Lum PJ, Ross WA, Raju GS, Lynch PM, Coronel E, Ge PS, Lee JH. Efficacy of uncovered colonic stents for extrinsic versus intrinsic malignant large bowel obstruction. Surg Endosc. 2021;35(8):4511-4519. https://doi.org/10.1007/s00464-020-07965-y
Ali FS, Gandam MR, Hussain MR, Mualla N, Khuwaja S, Sundararajan N, Siddiqui SI, Naqvi S, DaVee RT, Thosani N. Self-expanding metal stents for the treatment of malignant colon obstruction from extra-colonic malignancy versus intra-colonic malignancy: a systematic review and meta-analysis. Surg Endosc. 2023;37(6):4179-4192. https://doi.org/10.1007/s00464-023-09943-6
Baron TH, Wong Kee Song LM, Repici A. Role of self-expandable stents for patients with colon cancer. Gastrointest Endosc. 2012;75(3):653-662. https://doi.org/10.1016/j.gie.2011.12.020
Van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, Lee MS, Kwon SH, Mucci-Hennekinne S, Fockens P, Dijkgraaf MG, Repici A. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970-982. https://doi.org/10.1016/j.gie.2013.11.038
Lee YJ, Yoon JY, Park JJ, Park SJ, Kim JH, Youn YH, Kim TI, Park H, Kim WH, Cheon JH. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc. 2018;87(6):1548-1557. https://doi.org/10.1016/j.gie.2018.02.006
Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction — causes and contributing factors. Minimal Invas Ther Allied Technol. 2011;20(3):133-140. https://doi.org/10.3109/13645706.2010.518787
Pugaev AV, Achkasov EE. Obstructive tumor colonic obstruction: monograph. M.: INFRA-M; 2019. (In Russ.).
Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Colorectal Dis. 2011;13(8):935-938. https://doi.org/10.1111/j.1463-1318.2010.02325.x
Malik T, Lee M, Harikrishnan A. The incidence of stoma related morbidity — a systematic review of randomized controlled trials. Ann Royal College Surg Engl. 2018;100(7):501-508. https://doi.org/10.1308/rcsann.2018.0126
Klinicheskie rekomendacii. Koloproktologija. Pod red. Shelygina Ju.A. M.: GEOTAR-Media; 2015 (In Russ.).
Stojko Ju.M., Manihas G.M., Hanevich M.D., Konovalov S.V. Profilaktika i lechenie oslozhnenij kolostom. SPb.: Agraf+; 2008 (In Russ.).

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