140 Cases Experience of Self-expandable Metalic Stent Insertion for Colon and Rectum

Purpose: In the treatment of obstructive colorectal cancer, we should relieve ileus in the same time that we pursue improvement of operative curability and safety. To avoid emergency operation and to perform elective surgery without stoma creation after improvement of patients’ general condition, we use self-Expandable Metallic Stent (EMS) placement. We report the result of this therapy.
Methods: Since 1993, we have proactively performed EMS placement for the treatment of obstructive colorectal cancer and colorectal stricture associated introducing a guide wire under radiographic guidance and utilizing colonoscopy.
Results: A total of 140 patients underwent EMS placement for colorectal stricture during October 1993 and September 2009. Those included 97 bridge to surgery cases, 37 palliative purpose cases for unresectable malignant diseases, 5 anastomotic stricture cases and 2 benign (inflammation) colonic stricture cases. EMS insertion was able to be successfully performed in 130 cases (successful rate: 93%).
The bridge to surgery was able to be successfully performed in 89 cases (successful rate: 92%). Complications at the time of insertion were; 3 perforation cases in sigmoid colon (2%) and 2 migration in descending colon and rectum (1%). The surgery enabled 98% of total case to EMS insertion of bridge to surgery. The duration of preoperative EMS placement was 3-27 days (mean: 6.7 days). Postoperative complications included 1 wound infection, 1 ileus, 1 abdominal abscess and 1 leakage. These results are considered to be relatively favorable. The rate of stoma creation after bridge to surgery insertion was 11%, which is lower than the rate of 70% from the cases that EMS could not be placed. Circumferentially obstructive colorectal cancer often gives us difficult preoperative treatment, risk of contaminated operation and the need for secondary operation. But EMS enables us to obtain wider lumen to decrease the pressure of proximal intestine. It also enables us to inspect proximal intestine and to perform elective surgery after preoperative mechanical preparation.
In palliative purpose, EMS placement was able to be successfully performed in 33 cases (successful rate: 94%). Median of placement period was 170days after insertion. Complications at the time of insertion were 0 and 1 perforation cases in Rectosigmoid (3%) , 4 migration (11%) and 3 reobstruction (9%) in observation period after insertion.
EMS placement therapy has been effectively used in various situations.
Conclusions: To treat colonic obstruction, EMS placement therapy gives us significant meanings in the improvement of surgical results due to preoperative insertion and palliative purpose, and the avoidance of excess invasion and the improvement of patients’ QOL, Therefore, we believe that this procedure should be more and more employed and improved.

Session: Podium Presentation

Program Number: S090

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