Long term results of more than 100 self-expanding metallic stent (SEMS) placements for acute
malignant colonic obstruction
Zwaving HH1, Ledeboer M2, Ter Borg F2, Eddes EH1, Bosker RJÏ1, Eeftinck Schattenkerk M1
1Department
2Department
of Surgery, Deventer Ziekenhuis, Deventer
of Gastroenterology, Deventer Ziekenhuis, Deventer
Since 2003 all patients with an acute malignant colonic obstruction has been treated with placement of
a SEMS in our teaching hospital. Before or immediately after placement of the SEMS further
investigations are performed. For patients with evidence of diffuse metastatic disease or severe comorbidity SEMS was decided to be the definitive treatment. All other patients were scheduled for
curative resection within some weeks after SEMS placement. In this study we describe our results of
97 patients treated with a SEMS in the period 2003-2009.
In this period, 103 SEMS placements were performed. In 47 patients the SEMS was used as bridge to
surgery (BTS)(median age 75 years),in 50 patients as definitive treatment (median age 76 years).
In the BTS-group no SEMS related complications occurred. The clinical and technical success rate
was 96 percent. In one patient only partial relief of symptoms was achieved. One tumor obstruction
could not be passed. These two patients were operated within 24 hours after stent procedure.
The median time between SEMS placement and operation was 25 days (range 1-89). Resection types
were right hemicolectomy (10), transverse colectomy (7), left hemicolectomy (11), sigmoid resection
(13), low anterior resection (6). One temporarily diverting colostomy was performed. In three patients a
definitive colostomy was created as a Hartmann procedure. Seventy-one percent of the operated
patients had no complications. Post-operative complications were only minor, no anastomotic leakage
or intra-abdominal abscesses occurred. Mortality was low, one patient died 3 days after the operation
from a myocardial infarction (30 day mortality rate of 2%).
After a median follow-up of 25 months, local recurrence occurred in 3 patients, three patients
developed a second colonic malignancy.
In the palliative treated group most patients were known to have a colonic malignancy. Median
placement of a SEMS was 88 days after initial diagnostic endoscopy. The median survival after initial
diagnosis was 192 days. Thirty-six percent of the patients received chemotherapy. In some patients an
operation was unavoidable during follow-up. At last 11 patients underwent surgery in this palliative
setting. This was necessary because of tumor progression (2), dislocation (2), blow-out (2),
malfunction (3) and non passable tumor (3). All patients survived operation. Eight definitive
colostomies were performed. All other stents functioned well to death.
Conclusion: Mortality and morbidity of colonic resections after SEMS placement are low. In palliative
setting an operation cannot be avoided in all cases. With a good follow-up the number of operations
can still be low.