Three cases of endoscopic resection for synchronous early colon cancers after self-expandable metallic stent placement for obstructive colon cancer

Background and study aims: The feasibility of endoscopic resection for synchronous early colon cancer after placement of self-expandable metallic stents (SEMS) for malignant colorectal obstruction is unknown. Herein we evaluated 3 cases of endoscopic resection for synchronous early colorectal cancers after SEMS placement. Patient 1 was an 82-year-old man with obstructive sigmoid colon cancer. We curatively treated the synchronous descending colon cancer with endoscopic submucosal dissection (ESD) and the rectal cancer with endoscopic mucosal resection (EMR) after SEMS placement. This is the first reported case of a successful ESD for synchronous early colon cancer via the use of a colonic stent. Patient 2 was an 81-year-old man with obstructive ascending colon cancer. We resected the synchronous transverse colon cancer via ESD. Histologic findings indicated that the carcinoma cells had invaded the submucosal layer. Therefore, we immediately performed expanded right-hemicolectomy. Patient 3 was an 81-year-old man with obstructive sigmoid colon cancer. We curatively treated the synchronous transverse colon cancer with EMR after SEMS placement. There were no complications associated with the endoscopic treatments in any of the cases. Our results indicate that preoperative endoscopic resection combined with the ESD technique for synchronous colorectal cancer after SEMS placement could be effective as a surgical strategy for patients with malignant colorectal obstruction.

^* These authors contributed equally.

• References

• 1 Khot UP, Lang AW, Murali K et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002; 89: 1096-1102
• 2 Watt AM, Faragher IG, Griffin TT et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246: 24-30
• 3 Moroi R, Endo K, Ichikawa R et al. The Effectiveness of self-expandable metallic stent insertion in treating right-sided colonic obstruction: a comparison between SEMS and decompression tube placement and an investigation of the safety and difficulties of SEMS insertion in right colons. Gastroenterol Res Pract 2014; 2014: 372918
• 4 Bat L, Neumann G, Shemesh E. The association of synchronous neoplasms with occluding colorectal cancer. Dis Colon Rectum 1985; 28: 149-151
• 5 Kim JS, Lee KM, Kim SW et al. Preoperative colonoscopy through the colonic stent in patients with colorectal cancer obstruction. World J Gastroenterol : WJG 2014; 20: 10570-10576
• 6 Vitale MA, Villotti G, d'Alba L et al. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc 2006; 63: 814-819
• 7 Lim SG, Lee KJ, Suh KW et al. Preoperative colonoscopy for detection of synchronous neoplasms after insertion of self-expandable metal stents in occlusive colorectal cancer: comparison of covered and uncovered stents. Gut liver 2013; 7: 311-316
• 8 [Anonymous] The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: 3-43
• 9 Singh K, Narula AK, Thukral CL et al. Role of CT Colonography in Colonic Lesions and Its Correlation with Conventional Colonoscopic Findings. J Clin Diagn Res : JCDR 2015; 9: Tc14-18
• 10 Achiam MP, Logager V, Lund Rasmussen V et al. Perioperative colonic evaluation in patients with rectal cancer; MR colonography versus standard care. Acad Radiol 2015; 22: 1522-1528