Usefulness of a Self-expandable Metallic Stent for a Malignant Colorectal Obstruction

Chang, Yeon Soo; Lee, Kil Yeon; Lee, Suk Hwan; Yoon, Choong

Abstract

PURPOSE: Malignant colorectal obstruction is a common emergency situation showing high morbidity and mortality because of the poor general condition of the patients, unprepared bowel and advanced diseases. Recently, the self-expandable colorectal stent has allowed an elective one-stage resection without the risk of an emergency operation and stoma formation. We evaluated the usefulness of the self-expandable metallic stent for a malignant colorectal obstruction in terms of the preoperative preparation of the patients.
METHODS
Seventeen patients who underwent a surgical resection following self-expandable metallic stent insertion for a malignant colorectal obstruction were included in this study. The patients' characteristics, clinical courses, and complications after stent insertion, the changes in physical status of the patients, the operative method, and the postoperative complications were investigated. The APACHE II score was applied for evaluating the physical status of the patients.
RESULTS
Obstructions were located at the transverse (n=1), the descending (n=3), and the sigmoid colon (n=6) and at the rectum (n=7). Stents were successfully inserted and obstructions were relieved in all patients. Preoperative evaluations were performed in all cases. Fourteen of the 17 patients (82.4%) showed abnormal laboratory findings on admission. The average APACHE II score was 10.6 on admission and decreased to 7.8 after stent insertion (P<0.05). Nine patients (52.9%) could resume oral feeding after stent insertion. There were 2 stent-related complications, one case of stent migration and one case of minor bleeding; both were managed conservatively. At an average of 9 days after the stent insertion, an elective radical resection was conducted in all cases. Laparoscopic resections were attempted in 7 (41.2%) patients and were successful in 6. In 15 cases (88.2%), resection with primary anastomosis was possible. Postoperatively, there were 3 cases of wound infections and a temporary ileus. The TNM stage was stage II in 9 patients (52.9%), III in 6 (35.3%), and IV in 2 (11.8%). The patients were discharged from the hospital at an average of 11 days postoperatively.
CONCLUSIONS
Self-expandable colorectal stent insertion is a safe and effective treatment strategy and can change the emergency setting to permit an elective one-stage curative operation by allowing the general condition of a patient with malignant colorectal obstruction to recover.