Self-expandable Metallic Stents in Patients with Stage IV Obstructing Colorectal Cancer

The aim of the present study was to analyze the results of our experience with elective placement of self-expandable metallic stents (SEMS) in patients with stage IV obstructing colorectal cancer. A systematic review of the literature was also carried out to analyze the factors influencing the results of SEMS placement and to determine if there has been any improvement in the more recent period. The results of a personal series of 100 patients were analyzed. There was no case of mortality or major morbidity. The systematic review included 27 articles published from April 2007 to December 2011. In our experience the technical success rate was 96 % and the clinical success rate was 92 %. During the follow-up period a repeat colonoscopy was needed in 31 % of the patients for recurrent symptoms of obstruction due to fecal impaction (19 %), tumor growth (8 %), or stent dislodgment (4 %). Review of the literature showed similar results, with a significant improvement in the reports of the last 6 years; procedures performed on an emergency basis had poorer results. Self-expandable metallic stent placement offers a valid alternative to surgery in patients with obstructing stage IV colorectal cancer, but careful follow-up is required.