Clinical outcomes of endoscopic stent in curative and palliative management of malignant colonic obstruction: a retrospective cohort study

Malignant colonic obstruction (MCO) occurs in 10–18% of colorectal cancers. Traditionally, emergency surgery has been the standard treatment modality. However, it is associated with higher morbidity and mortality rates compared to patients undergoing elective surgery. With the advancement of endoscopic techniques, the self-expandable metal stent has been advocated as an alternative management that provides relief of obstructive symptoms, allowing the patient’s general condition to be restored and enabling elective surgery. Furthermore, the ability to complete staging allowed identification and avoidance of unnecessary surgery in patients with advanced disease who need palliative measures. However, various stent-related complications have been reported in the literature, including perforation, migration, and obstruction. In this study, we aimed to evaluate the success and complication rates of stent placement in MCO and compare short-term outcomes to those of upfront surgical management. We conducted a retrospective cohort study that included all patients with MCO between March 2015 and September 2021. Patients who had colon perforation at the time of the diagnosis, benign colonic obstruction, tumors of the rectum, or peritoneal metastasis that underwent cytoreductive surgery were all excluded. Patients were divided into groups according to the initial treatment, stent versus surgery, and the intent of therapy, curative versus palliative. Data was collected from medical records. Among 112 patients, 24 had stenting as a bridge to surgery (SBTS), and 16 underwent palliative stenting. The technical success rate was 95%, with failure in two patients due to complete obstruction and perforation in one patient each. Two patients (5%) who underwent stenting had clinical failure with persistent symptomatic obstruction beyond 48 h. The early complication rate following stent insertion was 8%, primarily due to perforation, obstruction from fecal impaction, and stent kinking. SBTS did not affect the laparoscopic approach or stoma creation rate among curative patients. However, it was associated with a more extended hospital stay. Half the patients who received stenting in the palliative group required re-stenting due to re-obstruction, with a mean stent patency time of 7 months. Management of MCO varies based on the patient’s clinical presentation, tumor site, and surgeon’s preference. Stent placement, whether as a bridge to surgery or as a palliative measure, is a safe, less invasive, and effective management option with success and low complication rates.