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Outcomes of stent insertion and mortality in obstructive stage IV colorectal cancer patients through 10 year duration

Abstract

Background

Colorectal stents are frequently used in patients with stage IV colorectal cancer with obstruction. However, there are only few studies on changes in outcomes of these patients and on the effect of stents on outcome over a long period of time with ongoing changes in therapeutic strategy, including chemotherapy.

Methods

We retrospectively evaluated 353 patients with bowel obstruction in stage IV colorectal cancer who underwent colonic stenting between years 2005 and 2014. The study population was divided into three groups based on time periods: 2005–2008, 2009–2011, and 2012–2014.

Results

The frequency of colorectal stent insertion procedure increased over the time periods (13.8%, 18.3%, and 20.8%, respectively). There were no changes in success rate and total complication rate. However, the early complication rate in the 3rd period was significantly lower than in the other periods (15.4% vs. 17.1% vs. 7.2%; P = 0.039). In the multivariate analysis, carcinomatosis (hazard ratio, 1.478; 95% confidence interval, 1.016–2.149; P = 0.041) and covered or partial-covered stent (hazard ratio, 1.733; 95% confidence interval, 1.144–2.624; P = 0.009; hazard ratio, 1.988; 95% confidence interval, 1.132–3.493; P = 0.017, respectively) were associated with increased complication rate. Stent-related perforation was an independent risk factor related with increased mortality. Although survival duration increased over time (P = 0.042), the mortality rate was unchanged across the three time periods.

Conclusions

Over 10 years, the targeted agent use and survival duration increased, and early complication rate was decreased, without change in late complication rate or mortality rate during the three time periods in patients with obstructive stage IV colorectal cancer and stent insertion.

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Fig. 1

Abbreviations

CRC:

Colorectal cancer

SEMS:

Self-expandable metal stent

5-FU:

5-Fluorouracil

CEA:

Carcinoembryonic antigen

ECOG:

Eastern cooperative oncology group

VEGF:

Vascular endothelial growth factor

IQR:

Interquartile range

HRs:

Hazard ratios

CIs:

Confidence intervals

LV:

Leucovorin

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Author information

Correspondence to Tae Il Kim.

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Disclosures

Yong Eun Park: acquisition of data, analysis and interpretation of data, drafting of the manuscript. Yehyun Park: critical revision of the manuscript for important intellectual content. Soo Jung Park, Jae Hee Cheon, and Won Ho Kim: critical revision of the manuscript for important intellectual content. Tae Il Kim: acquisition of data; study concept and design; critical revision of the manuscript for important intellectual content. All authors approved the final version of the article, including the authorship list. Dr. Yong Eun Park, Dr. Yehyun Park, Dr. Soo Jung Park, Dr. Jae Hee Cheon, Dr. Won Ho Kim, and Dr. Tae Il Kim have no conflict of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1. The percentage of colorectal stenting patients in stage IV colorectal cancer patients over 10 years (2005-2014) (P<0.001) (TIF 287 KB)

Supplementary material 2. The trend of inserted stent types in obstructive stage IV colorectal cancer patients over 10 years (P<0.001) (TIF 761 KB)

Supplementary material 3. The trend of complication rate of colorectal stent insertion in obstructive stage IV colorectal cancer patients over 10 years. (A) Early and late complications of stent insertion. *P value for early complication among the three time periods (P=0.039). (B) Complication rates based on their types (all P>0.05): i) perforation rate; 11.0%, 4.9%, and 6.5% (P=0.213), ii) re-obstruction rate; 20.9%, 27.6%, and 18.7% (P=0.206), iii) migration rate; 3.3%, 3.3%, and 1.4% (P=0.566), iv) bleeding rate; 2.2%, 1.6%, and 2.9% (P=0.793). (TIF 458 KB)

Supplementary material 4. The trend of management in obstructive stage IV colorectal cancer patients with stent insertion over 10 years. *P value for targeted chemotherapeutic agents among the three time periods (P<0.001). (TIF 398 KB)

Supplementary material 5. The trend of management in obstructive stage IV colorectal cancer patients with stent insertion over 10 years. *P value for targeted chemotherapeutic agents among the three time periods (P<0.001). (TIF 285 KB)

Supplementary material 6 (DOCX 40 KB)

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Park, Y.E., Park, Y., Park, S.J. et al. Outcomes of stent insertion and mortality in obstructive stage IV colorectal cancer patients through 10 year duration. Surg Endosc 33, 1225–1234 (2019). https://doi.org/10.1007/s00464-018-6399-2

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Keywords

  • Colon stent
  • Colorectal neoplasm
  • Stage IV
  • Outcome
  • Mortality