Background and Aims

Colonic stent placement in patients with large-bowel obstruction (LBO) secondary to extracolonic malignancy (ECM) has been evaluated in small series with heterogeneous results. Our aim is to better characterize the technical and clinical success of colonic stent placement and to identify factors that affect this success in ECM patients.

Methods

All patients at a single high-volume center who presented for colonic stent placement for LBO because of ECM between 2001 and 2012 were retrospectively identified. The outcomes of interest were technical success, clinical success, stent occlusion rate, and overall survival.

Results

A total of 187 patients were identified. Mean age was 61.9 years (range, 23-89), and 150 (80.2%) were women. The most common malignancy type was urogynecologic (n = 104) and most common location sigmoid colon (n = 128). Overall, 142 patients (75.9%) achieved technical success and 102 patients (54.5%) clinical success. Radiographic presence of peritoneal carcinomatosis (P < .001) and multifocal disease (P < .001) were associated with both decreased technical and clinical success. Procedure-related adverse events were seen in 12 patients (6.4%). In patients with clinical success, the incidence of stent occlusion at 3 months was 14.7% (95% confidence interval, 7.8%-21.6%) and was higher in patients with prior radiation therapy (P = .011). The median overall survival for all patients from time of attempted stent placement was 3.3 months (95% confidence interval, 3.0-4.1).

Conclusions

This study represents the largest retrospective series of colonic stent placement for LBO in ECM patients in the literature. Our technical success rate of 75.9%, clinical success rate of 54.5%, and 3-month stent occlusion rate of 14.7% suggest that stent placement is a viable palliative option for patients with advanced disease because of ECM. Patients with peritoneal carcinomatosis and multifocal disease have reduced technical and clinical success. However, these factors should not dissuade an attempt at stent placement, if risk-to-benefit analysis is favorable.

中文翻译：

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结肠外恶性肿瘤引起的恶性大肠梗阻患者结肠支架临床结局的预测因素

背景和目标

结肠外恶性肿瘤 (ECM) 继发的大肠梗阻 (LBO) 患者的结肠支架置入已在小系列中进行了评估，结果各不相同。我们的目标是更好地表征结肠支架置入术的技术和临床成功，并确定影响 ECM 患者成功的因素。

方法

对 2001 年至 2012 年间因 ECM 因 LBO 接受结肠支架置入术的单一高容量中心的所有患者进行了回顾性鉴定。感兴趣的结果是技术成功、临床成功、支架闭塞率和总生存率。

结果

共确定了 187 名患者。平均年龄为 61.9 岁（范围，23-89 岁），150 人（80.2%）为女性。最常见的恶性肿瘤类型是泌尿妇科（n = 104）和最常见的位置乙状结肠（n = 128）。总体而言，142 名患者 (75.9%) 取得了技术成功，102 名患者 (54.5%) 取得了临床成功。腹膜癌病 ( P  < .001) 和多灶性病变 ( P  < .001) 的影像学检查与技术和临床成功率降低有关。12 名患者 (6.4%) 出现了与手术相关的不良事件。在临床成功的患者中，3 个月时支架闭塞的发生率为 14.7%（95% 置信区间，7.8%-21.6%），并且在既往接受过放射治疗的患者中更高（P = .011）。从尝试放置支架开始，所有患者的中位总生存期为 3.3 个月（95% 置信区间，3.0-4.1）。

结论

本研究代表了文献中最大的 ECM 患者 LBO 结肠支架置入回顾性系列。我们 75.9% 的技术成功率、54.5% 的临床成功率和 14.7% 的 3 个月支架闭塞率表明，对于因 ECM 导致的晚期疾病患者，支架置入术是一种可行的姑息治疗选择。腹膜癌病和多灶性疾病患者的技术和临床成功率降低。然而，如果风险收益分析是有利的，这些因素不应阻止尝试放置支架。