OBJECTIVE
To determine the predictors of perforation following colorectal stenting for malignant stricture.
MATERIAL AND METHODS
We retrospectively analyzed 314 patients with acute obstructive intestinal obstruction caused by colorectal cancer who underwent stenting of stricture. The main clinical parameters were technical success and clinical effect, mortality, complication rate and predictors of perforation.
RESULTS
Technical success rate of colorectal stenting was 98% (308 patients), clinical success rate — 89% (282 patients). Complications after stenting were noted in 30 (9.5%) patients: colon perforation — 18 (5.7%) patients, stent migration — 8 (2.5%) patients, bleeding — 4 (1.3%) patients. According to univariate and multivariate logistic regression analysis, tumor location at the site of physiological curvature, total colon obstruction (luminal diameter ≤2 mm), diverticula at the site of stent placement, stage IV tumor process, carcinomatosis and dilation of stricture before colon stenting were significant prognostic factors of complications (colon perforation) OR 3.049 (95% CI 2.723—4.329), p=0.003; OR 1.214 (95% CI 1.114—1.886), p=0.002; OR 2.562 (95% CI 1.954—3.658), p=0.001; OR 1.801 (95% CI 1.205—2.693), p=0.004; OR 1.305 (95% CI 1.117—2.266), p=0.003; and OR 1.352 (95% CI 1.211—2.431), p=0.002, respectively) and OR 3.453 (95% CI 2.954—5.123), p=0.004; OR 1.321 (95% CI 1.182—2.121), p=0.001; OR 2.981 (95% CI 2.223—4.121), p=0.003; OR 2.427 (95% CI 1.406—4.187), p=0.001; OR 1.909 (95% CI 1.326—3.726), p=0.001; and OR 1.472 (95% CI 1.341—2.156), p=0.004, respectively).
CONCLUSION
Colorectal stenting for acute intestinal obstruction is an effective and safe treatment option. Predictors of colon perforation in colorectal stenting are tumor location at the site of physiological bending, total colon obstruction (luminal diameter ≤2 mm), diverticula at the site of stent placement, stage IV tumor process, carcinomatosis and dilation of stricture before colon stenting.
