Faraz S, et al. - The physicians aimed to better characterize the technical and clinical success of colonic stent placement. Furthermore, they identifed factors that affect this success in extra colonic malignancy (ECM) patients. Findings revealed the largest retrospective series of colonic stent placement for large-bowel obstruction (LBO) in ECM patients in the literature. The technical success rate was found to be 75.9%, the clinical success rate was 54.5% and 3-month stent occlusion rate was 14.7%. This data suggested that stent placement was a viable palliative option for patients with advanced disease due to ECM. Reduced technical and clinical success were found in patients with peritoneal carcinomatosis and multifocal disease. However, if the risk-benefit analysis was favorable, these factors would not dissuade an attempt at stent placement.

Methods

• The physicians retrospectively identified all patients at a single high-volume center who presented for colonic stent placement for LBO due to ECM between 2001 and 2012.
• Technical success, clinical success, stent occlusion rate and overall survival were the outcomes of interest.

Results

• The physicians identified 187 patients.
• In this study, mean age was 61.9 years (range 23-89) and 150 (80.2%) were female.
• Urogynecologic (n=104) and sigmoid colon (n=128) were the most common malignancy type and location, respectively.
• Technical success was achieved in 142 patients (75.9%) and 102 patients (54.5%) reported clinical success.
• Radiographic presence of peritoneal carcinomatosis (p<0.001) and multifocal disease (p<0.001) were correlated with both decreased technical and clinical success.
• They observed procedure-related adverse events in 12 patients (6.4%).
• The incidence of stent occlusion at 3 months was 14.7% (95% CI, 7.8%-21.6%) in patients with clinical success and was higher in patients with prior radiation therapy (p=0.011).
• For all patients, the median overall survival was 3.3 months (95% CI, 3.0-4.1 months) from the time of attempted stent placement.