Clinical use of the self-expanding metallic stent in the management of colorectal cancer

PURPOSE: This report describes our experience with the use of self-expandin g metallic stents (SEMS) in the management of obstructing colorectal cancer . METHODS: A retrospective chart review of ail patients undergoing placement of SEMS between May 1997 and January 2000 was performed. RESULTS: Insertion of SEMS was attempted in 12 patients. Successful stent placement was achie ved in 10 of the 12 patients. The locations of lesions were hepatic flexure (2), splenic flexure (1), left colon (1), sigmoid colon (4) and rectum (4) . The intended uses of SEMS were for palliation in 3 patients and as a brid ge to elective surgery in 9. In the latter group, SEMS placement allowed fo r preoperative bowel preparation in 4 patients and administration of neoadj uvant therapy prior to elective surgery in 2 patients. One patient died pri or to definitive surgery. Stent placement was unsuccessful in 2 patients. T hree SEMS-related complications occurred; 1 stent migrated and 1 stent obst ructed secondary to tumor ingrowth. One patient died 13 days after stent pl acement and colonic decompression. CONCLUSIONS: SEMS represent a useful toot in the management of obstructing colorectal neoplasms. As a bridge to surgery, SEMS provide time for a compl ete preoperative evaluation and a mechanical bowel preparation and may obvi ate the need for fecal diversion or on-table lavage. It may also allow for time to administer neoadjuvant therapy when indicated. As a palliative meas ure, SEMS can eliminate the need for an operation. (C) 2001 by Excerpta Med ica, Inc.