ABSTRACT
Up to 85% of patients who present with colonic obstruction have a colorectal cancer. Between 7% and 29% of these patients present with total or partial intestinal obstruction. Only 20% of these patients presenting with acute colonic obstruction due to malignancy survive 5 years. Emergent surgical intervention in patients with colonic obstruction is associated with significant morbidity and mortality rates. Only 40% of patients with obstructive carcinoma of the left colon can be treated with surgical resection without the need for a colostomy. The use of a temporary or permanent colostomy has a significant impact on quality of life. The decompressive effect seen with colonic stenting is a durable, simple, and effective palliative treatment of patients with advanced disease. Stent deployment provides an effective solution to acute colonic obstruction and allows surgical treatment of the patient in an elective and more favorable condition. In addition, colonic stenting reduces costs and avoids the need for a colostomy.
KEYWORDS
Colon cancer - intestinal obstruction - colonic stenting
REFERENCES
1
Boyle P, Leon M.
Epidemiology of colorectal cancer.
Br Med Bull.
2002;
64
1-25
2
Deans G T, Krukowski Z H, Irwin S T.
Malignant obstruction of the left colon.
Br J Surg.
1994;
81
1270-1276
3
Duxbury M, Brodribb A, Oppong F, Hosie K.
Management of colorectal cancer: variations in practice in one hospital.
Eur J Surg Oncol.
2003;
29
400-402
4
Griffith R.
Prospective medical obstacles to surgery.
Cancer.
1992;
70
1333-1341
5
Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T.
Emergency surgery for colon carcinoma.
Dis Colon Rectum.
2003;
46
24-30
6
Ohman U.
Prognosis in patients with obstructing colorectal carcinoma.
Am J Surg.
1982;
143
742-747
7
Witzig J A, Morel P, Erne M, Egeli R, Borst F, Rohner A.
Chirugie des cancers digestifs des patients de plus de 80 ans.
Helv Chir Acta.
1993;
59
767-769
8
Barillari P, Aurello P, de Angelis R et al..
Management and survival of patients affected with obstructive colorectal cancer.
Int Surg.
1992;
77
251-255
9
Neugent K, Daniels P, Stewart B, Patankar R, Johnson C D.
Quality of life in stoma patients.
Dis Colon Rectum.
1999;
42
1569-1574
10
Dohmoto M, Rupp K D, Hohlbach G.
Endoscopically-implanted prosthesis in rectal carcinoma.
Dtsch Med Wochenschr.
1990;
115
915
11
Cwikiel W, Andren-Sandberg A.
Malignant stricture with colovesical fistula: stent insertion in the colon.
Radiology.
1993;
186
563-564
12
Keen R, Orsay C P.
Rectosigmoid stent for obstructing colonic neoplasms.
Dis Colon Rectum.
1992;
35
912-913
13
Tejero E, Mainar A, Fernandez L, Tobio R, de Gregorio M A.
New procedure for the treatment of colorectal neoplastic obstructions.
Dis Colon Rectum.
1994;
37
1158-1159
14
Zollikofer C, Jost R, Schonh E, Decurtins M.
Gastrointestinal stenting.
Eur Radiol.
2000;
10
1158-1159
15
Mauro M, Koehler R, Baron T.
Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.
Radiology.
2000;
215
659-669
16
de Gregorio M A, Mainar A, D'Agostino H, Herrera M, Tejero E, Medrano J.
Trasanal metallic stents for malignant colonic obstructions in 126 patients.
J Vasc Interv Radiol.
1999;
10(suppl)
219
17
Mainar A, de Gregorio M A, Tejero E et al..
Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery-results of a multicenter study.
Radiology.
1999;
210
65-69
18
Mischima R, Sawada S, Tanigawa N, Okuda Y, Kobayashi M, Koyama T.
Expandable metallic stent treatment for malignant colorectal strictures.
Cardiovasc Interv Radiol.
1999;
22
155-158
19
Akle C A.
Endoprostheses for colonic strictures.
Br J Surg.
1998;
85
310-314
20
Song H Y.
Malignant gastric outlet obstruction: treatment by means of coaxial placement of uncovered and covered expandable Nitinol stents.
J Vasc Interv Radiol.
2002;
13
275-283
21
Canon C L, Baron T H, Morgan D E, Dean P A, Koeler R E.
Treatment of colonic obstruction with expandable metal stents: radiologic features.
AJR Am J Roentgenol.
1997;
168
199-205
22
Lopera J E, Ferral H, Wholey M, Maynar M, Castaneda-Zuniga W R.
Treatment of colonic obstructions with metallic stents: indications, technique and complications.
AJR Am J Roentgenol.
1997;
169
1285-1290
23
Adamsen S, Holm J, Meisner S, Moller P, Naver L P, Wille-Jorgensen P A.
Endoscopic treatment of colorectal obstruction with self-expandable metal endoprosthesis.
Ugeskr Laeger.
2000;
162
1560-1563
24
Choo I, Do Y, Suh S et al..
Malignant colorectal obstruction: treatment with a flexible covered stent.
Radiology.
1998;
206
415-421
25
de Gregorio M A, Mainar A, Tejero E, Alfonso E R, Gimeno M J, Herrera M.
Use of an introducer sheath for colonic stent placement.
Eur Radiol.
2002;
12
2250-2252
26
Velling T E, Hall L D, Brennan F J.
Colonic stent placement facilitated by percutaneous cecostomy and antegrade enema.
AJR Am J Roentgenol.
2000;
175
119-120
27
Gimeno M J, Alfonso E R, Herrera M, Tobio R, Medrano J, de Gregorio M A.
Palliative treatment of malignant stenoses of transverse colon by autoexpandable metallic stent through percutaneous cecostomy or colostomy.
Cardiovasc Intervent Radiol.
2002;
25(suppl)
208
28
Binkert C A, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer C.
Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents-a preliminary report.
Radiology.
1998;
206
199-204
29
de Gregorio M A, D'Agostino H, Gimeno M J et al..
Trasanal colonic stent implantation under fluoroscopy alone and under fluoroscopy and endoscopy. A comparative study.
Interventionismo.
2003;
5
103-111
30
Khot U, Lang A, Murali K, Parker M.
Systematic review of the efficacy and safety of colorectal stents.
Br J Surg.
2002;
89
1096-1102
31 Beltran J M. Left obstructive colonic carcinoma. Comparative study of short and middle-term results after a new therapeutic procedure based in self-expanding metallic stents placement [doctoral thesis]. Zaragoza, Spain; Universidad de Zaragoza 2003
32
Martinez C, Lobato R, Fradejas J M, Pinto I, Ortega P, Moreno M.
Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates.
Dis Colon Rectum.
2002;
45
401-406
33
Harris G, Senagore A, Lavery I, Fazio V.
The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices.
Am J Surg.
2001;
181
499-506
34
Odurny A.
Colonic anastomotic stenoses and Memotherm stent fracture: a report of three cases.
Cardiovasc Intervent Radiol.
2001;
24
336-339
35
Osman H, Rashid H, Sathananthan N, Parker M.
The cost-effectiveness of self- expanding metal stents in the management of malignant left-sided bowel obstruction.
Colorectal Dis.
2000;
2
233-237
36
de Gregorio M A, Mainar A, Gimeno M J et al..
Radiation exposure during metallic stent placement for the treatment of malignant colonic obstruction: experience with 12 patients.
Cardiovasc Intervent Radiol.
2001;
24
S189
37
Gimeno M J, Medrano J, Alfonso E R, de Gregorio M A.
Utility of fluoroscopy combined with endoscopy in the treatment of malignant colorectal stenosis with metallic stents.
Cardiovasc Intervent Radiol.
2002;
25
S203
38
Turegano F, Echenagusia A, Simo A et al..
Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.
Br J Surg.
1998;
85
232-235
39
Baron T H.
Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.
N Engl J Med.
2001;
344
1681-1687
40
Maynar M, Qian Z.
Current status of the expandable metallic stent for the treatment of colorectal obstruction.
Cardiovasc Intervent Radiol.
2001;
21(suppl)
114-116
Prof. Miguel Angel de Gregorio Ariza
Department of Interventional Radiology, Hospital Clinico Universitario
San Juan Bosco 15
Zaragoza 50009, Spain
Email: mgregori@separ.es