Self-expandable metallic stent for treatment of malignant colorectal strictures in elderly patients: our experience
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KeywordsStent Insertion Colonic Obstruction Endometrial Adenocarcinoma Large Bowel Obstruction Plain Abdominal Radiograph
Intrinsic obstruction caused by primary or recurrent adenocarcinoma and extrinsic invasion/compression due to pelvic malignancies represent the main causes for malignant colorectal obstruction. Most of the patients with acute or chronic large bowel obstruction are often in poor general condition (severe dehydration, electrolytes imbalance, advanced age, co-pathology) facing high risks as surgical candidates. Self-Expandable metallic stents (SEMS) allow rapid decompression of colonic obstruction reducing operative procedures of 23% and number of colostomies from 43% to 7%, which result in a worsening of the quality of life and higher costs. The end-point of our preliminary experience is to evaluate if colonic stenting is feasible for both palliation or "bridge" to surgery in elderly patients.
Materials and methods
In all patients successful decompression, defined as complete relief of bowel obstruction as judged by clinical symptoms and radiographic observation, was achieved. No precocious or posthumous complications were observed. The first patient died 1 month later for disease progression. The second patient underwent the VIII cycle with Adriamicina and Cisplatino. At 9 months from stent insertion a CT exam showed disease progression, no sign of stent dislocation (Figures 5, 6). The last patient has completed the I cycle with FOLFOX.
Our experience suggests that colonic stenting in elderly patients is safe and minimally invasive, allowing a colonic decompression in both intrinsic and extrinsic neoplasia, with a better quality of life, less morbidity, mortality and costs. It doesn't affect the median survival compared with surgery.
This article is published under license to BioMed Central Ltd.