Abstract
Background and Study Aims: Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction.
Patients and Methods: In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals.
Results: Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting.
Conclusion: Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.
