Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent (SEMS) insertion for malignant colorectal obstruction

Abstract

PURPOSE: Although self-expanding metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, immediate technical and clinical failure rates of SEMS and the associated risk factors remain largely unknown. The aim of this study was to identify rates and factors predictive of technical and clinical failure of SEMS when attempted for the decompression of malignant colorectal obstruction.METHODS: A total 412 patients, including 276 as an approach of palliation in advanced disease and 136 as a bridge to curative surgery, were attempted to receive SEMSs insertion at Severance Hospital between November 2005 and December 2009. The definition of technical failure was incapablility to deploy a stent across the stricture. Clinical failure was defined as absence of the relief of obstructive symptoms.RESULTS: Technical and clinical failures were found in 36 of 276 (13.0%) and 39 of 240 patients (16.3%) in the palliative group and in 3 of 136 (2.2%) and 7 of 133 (5.3%) of patients in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, presence of carcinomatosis, and proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of tumor. In the preoperative group, only older patients had both higher technical and clinical failures rates.CONCLUSIONS: Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMS found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.