NEW YORK (Reuters Health) Jan 17 - Self-expandable metal stents (SEMS) are a safe and effective approach to treating colorectal obstruction due to malignant disease, new findings suggest.
As many as 20% of patients with colorectal cancer will develop symptomatic obstruction, and about a third of those cases will be inoperable, according to coauthors Dr. Roberto Di Mitri of the ARNAS-Civico-Di Christina-Benfratelli Hospital in Palermo, Italy, and colleagues.
Stents can be used as a bridge to surgery or as a palliative treatment, they add, but studies have found high rates of complications, including migration, obstruction and perforation.
Dr. Di Mitri's team gathered data from eight hospitals in Sicily on 204 patients treated with SEMS for obstructive colorectal cancer between 2008 and 2012. About a third were treated emergently, they reported online December 8 in Digestive and Liver Diseases.
Thirty percent received SEMS as a bridge to surgery. Stenting in the others was palliative.
The technical success rate was 99% and the clinical success rate was 94.6%, the researchers report.
Seventeen patients developed neoplastic ingrowths, 10 had stent migration, and four had perforation. Patients treated palliatively were more likely to have stent ingrowth, while ingrowth was less likely among those receiving chemotherapy.
Perforation is the "most serious and worrisome complication" with stenting for malignant colon obstruction, Dr. Todd Baron Sr. of the University of North Carolina noted in an interview. Dr. Baron reviewed the new study for Reuters Health.
The rate of perforation in this series was "acceptably low," Dr. Baron added. It's interesting, he said, that chemotherapy was linked to a lower rate of stent ingrowth without increasing the risk of perforation.
"Overall I think it's supportive of the use of stents," Dr. Baron said.
While there was initially a great deal of enthusiasm for the use of stents to treat malignant obstruction of the colon, Dr. Baron added, "My sense is that some of the enthusiasm has been quelled by bad outcomes in randomized trials."
However, he added, nonrandomized studies like the current series have shown better outcomes.
Stenting the colon is a technically difficult procedure, Dr. Baron noted. "People in the community still need to be cautious, because I'm not sure that the results can be entirely duplicated in community practices."
SOURCE: http://bit.ly/19AeJtm
Dig Liver Dis 2013.
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