PURPOSE: Malignant large bowel obstruction (LBO) is a common problem in patients with advanced or recurrent gynecologic malignancy. Studies reviewing palliative surgery have suggested variable short-term success with significant morbidity and diminished quality of life. The purpose of this study is to review our experience and examine the efficacy of intraluminal stents in the management of LBO secondary to pelvic malignancy.
METHODS: Between 2000 and 2006, six patients (mean age = 64 years) with advanced and/or recurrent gynecologic malignancy (Stage III or IV) underwent intraluminal stent placement for malignant LBO using fluoroscopic technique. Only patients with LBO confined to one area were considered. Data were collected from patient charts and operative notes. Palliation of obstruction and post-stent complications were assessed retrospectively.
RESULTS: Six patients underwent successful stent placement (ovarian cancer (n=3); endometrial cancer (n=3). Obstruction was most commonly located in the distal sigmoid colon and rectum: sigmoid colon/rectum (n=4), left colon (n=1), and transverse colon (n=1). Early relief of obstructive symptoms was achieved in 4 of 6 patients (67 percent). Complications occurred in 5 of 6 patients (83 percent): reobstruction (n=3), bacteremia (n=1), perforation (n=1), and stent migration (n=1). One of three patients with subsequent obstruction required a second stent placement during the same hospital admission. This patient subsequently died two days after the second stent insertion. On average, time to death after stent insertion was 1.5 months.
CONCLUSIONS: Malignant LBO is not an uncommon cause of death in patients with advanced gynecologic malignancy. Median survival has been reported to be less than 3 months from the time of diagnosis. Multiple palliative approaches have been described in the literature, including repeat resection or intestinal bypass, fecal diversion, and intraluminal colonic stenting. Our experience with intraluminal stenting demonstrated short-term relief of obstructive symptoms in 67 percent of patients. This is comparable to other reports in the literature. However, our high complication rate and low median survival were not characteristic of these other studies. Although the use of colonic stenting is a reasonable option for the palliative treatment of malignant LBO, other options, including palliative surgery, should be re-examined.
Program Number: P136