Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies

The aim of this study is to report our experience gained after attempted colonic stenting for colonic obstruction from extracolonic cancer.

This is a retrospective study of all patients who had attempted colonic stenting for obstructing extracolonic cancer in a district general hospital from November 1998 to November 2008.

During the study period, a total of 12 stent procedures were carried out in 11 patients with colonic obstruction from extracolonic cancer and were analysed further. These represented 8.5% of a total of 141 stent procedures performed in 130 patients. Fluoroscopic technique was used alone. The median age was 73 years with a range from 47 to 88 years. The underlying malignancy was ovarian in five, urinary bladder in one, kidney in one, prostatic in one, breast in one, cholangiocarcinoma in one and carcinoid in one. The technical and clinical success rate was 42% and 25%, respectively. The 30-day mortality rate was 36%. Stent-related complications included one perforation. The colostomy formation rate was 45%. Only two patients survived over a month with a stent and without a subsequent colostomy. The median survival time was 2 months. The 3-, 6- and 12-month survival rate was 36%, 18% and 9%, respectively.

Our experience does not support the routine use of colonic stenting for extracolonic cancer obstructing the colon. A more realistic approach is necessary including either the acceptance that the obstruction represents a life-ending event or proceeding immediately to a colostomy. Decisions should be individualised and stenting used after recognising its shortcomings.