Techniques in coloproctology · 2026
Self-expandable metal stent (SEMS) placement for malignant colonic obstruction in palliative patients: post-procedural morbidity and long-term outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Serrano-Navidad M, Kreisler E, Alba E, Biondo S
Аннотация
BACKGROUND: Self-expandable metal stents (SEMS) are recommended as a first-line treatment for malignant colonic obstruction in palliative patients. However, published outcomes remain controversial. This study aimed to evaluate the morbidity associated with SEMS placement in patients with tumor-related colonic obstruction in a palliative setting. Secondary objectives included long-term outcomes and the impact on subsequent oncological treatment.
METHODS: A retrospective study was conducted on 146 consecutive palliative oncological patients treated at a tertiary center between 2008 and 2023. Patients were categorized into three groups based on the cause of palliation: unresectable stage IV colon cancer (Group I), colon cancer with comorbidities and poor performance status (Group II), and extrinsic compression from extracolonic malignancies (Group III).
RESULTS: Clinical resolution of obstruction was achieved in > 80% of patients, with significant differences among groups (88% in Group I, 79% in Group II, and 59% in Group III; p = 0.009). Early morbidity occurred in 38% of cases and severe complications (≥ Clavien-Dindo III) in 31%. Morbidity was more frequent in Group III (65%). Thirty-day mortality was 15%. Only 12% of patients resumed chemotherapy after SEMS placement, with a median delay of 34 days. Median overall survival after SEMS placement was 4 months. Over 95% of patients died because of disease progression.
CONCLUSIONS: SEMS placement in palliative patients is effective in relieving obstruction but carries a high risk of complications, especially in extracolonic malignancies. Less than a third of patients continue oncological treatment after stenting, highlighting the need for careful patient selection.
METHODS: A retrospective study was conducted on 146 consecutive palliative oncological patients treated at a tertiary center between 2008 and 2023. Patients were categorized into three groups based on the cause of palliation: unresectable stage IV colon cancer (Group I), colon cancer with comorbidities and poor performance status (Group II), and extrinsic compression from extracolonic malignancies (Group III).
RESULTS: Clinical resolution of obstruction was achieved in > 80% of patients, with significant differences among groups (88% in Group I, 79% in Group II, and 59% in Group III; p = 0.009). Early morbidity occurred in 38% of cases and severe complications (≥ Clavien-Dindo III) in 31%. Morbidity was more frequent in Group III (65%). Thirty-day mortality was 15%. Only 12% of patients resumed chemotherapy after SEMS placement, with a median delay of 34 days. Median overall survival after SEMS placement was 4 months. Over 95% of patients died because of disease progression.
CONCLUSIONS: SEMS placement in palliative patients is effective in relieving obstruction but carries a high risk of complications, especially in extracolonic malignancies. Less than a third of patients continue oncological treatment after stenting, highlighting the need for careful patient selection.