'Real-world' experience of colonic stents for obstructive colon cancer-feasible and safe with low morbidity and mortality
Aim: To define the 'real-world' incidence of technical and clinical success, morbidity and mortality in consecutive patients undergoing self-expanding metallic stent (SEMS) implantation for obstructive colonic cancer. Method: Retrospective review of 163 patients undergoing SEMS at two centres (Royal Derby Hospital, UK and Chesterfield Royal Hospital, UK) between 2008 and 2016 cross-referenced with electronic databases for accuracy. Results: 163 patients received a total of 188 SEMS over a 99 month. The mean age was 72 (range 26-102). 82 (49.5%) presented with features of acute or sub-acute obstruction, 37 (22.7%) as a surgical emergency, 8 (5%) with fistulating tumors and 12 (7.4%) received SEMS as a bridge to semi-elective curative surgery. There were high rates of technical and clinical success (89% and 88% respectively) with a low overall incidence of complications (3.2%). Major complications included 2 (1.1%) early (<1 month) stent migrations, 4 (2.1%) perforations (day 0, 5 and 12) but no significant haemorrhage. Overall major complication rate of 6/188 (3.2%). Delayed stent migration (>1 month) occurred in 2 patient. Overall 10 procedures (6.1%) were abandoned for various reasons including that the lesion could not be crossed. Information on overall 30 day mortality (1/96, 1.04%) was available at Royal Derby Hospital. Conclusion: In this large 'real-world' case series SEMS was technically feasible with high levels of technical and clinical success and low 30-day morbidity and mortality. These results support the positive findings of randomised trials and the use of SEMS for palliation and in selected patients prior to staged surgical resection.