Efficacy of self-expandable metallic stents (SEMS) for obstructive colorectal cancer

Abstract

Purpose: Emergency surgery for obstructive colorectal cancer is known to have an increased risk of perioperative complications. Conservative therapy primarily involves decompression through the placement of a transnasal or a transanal ileus tube. However, the self-expandable metallic stent (SEMS) became available with insurance coverage in Japan in January 2012. Here, we evaluated the usefulness of SEMS in cases of colon cancer ileus treated at our institution. Methods: Of 1,065 patients who underwent colon cancer surgery in our department from January 2005 to November 2013, 286 had obstructions. SEMS was used in patients with lesions from the transverse colon to the anal side. Patients who did not need decompression and those with lesions from the transverse colon to the oral side were excluded. Of the patients with obstructive colorectal cancer, 32 received SEMS, 27 received a transanal ileus tube, and 39 underwent emergency surgery, and 501 had elective surgery. We examined the patients' background factors and perioperative courses. Results: The SEMS group had a significantly lower stoma creation rate than the transanal ileus tube and emergency surgery groups. The SEMS group also had significantly higher primary anastomosis, and laparoscopic surgery rates than the other groups. A meta-analysis suggested that the use of SEMS significantly contributed to a lower stoma creation rate. Conclusion: The SEMS can help prevent the need to create a stoma, enables the use of radical and less invasive surgeries, and is useful in cases of colon cancer ileus.