Short-Term Efficacy and Long-Term Limitations of Self-Expandable Metallic Stent Placement for Colorectal Obstruction due to Extracolonic Malignancies.

[OBJECTIVES] Although previous studies have investigated colonic stenting for obstruction due to extracolonic malignancies (ECMs), long-term data-especially concerning quality of life and chemotherapy resumption-remain insufficient.

[METHODS] Clinical data of 25 patients with ECM-induced colorectal obstruction were retrospectively analyzed. The primary endpoint was the obstruction-free duration after stenting. The secondary endpoints included successful stent placement, the clinical course after stent placement, and the outcomes of stent occlusion treatment.

[RESULTS] Median age was 69 years, and gastric cancer was the most frequent primary malignancy. Obstruction was caused by peritoneal dissemination ( = 21) or direct infiltration ( = 4). Stent placement was successful in 86% and 100% of the respective groups, without procedure-related adverse events. Among 22 successful placements, bowel obstruction relief was achieved in 83.3% with peritoneal dissemination and 100% with direct infiltration. Eleven patients (50%) discontinued intravenous nutrition, and seven (31.8%) resumed chemotherapy. Ten patients (45%) were discharged. The median obstruction-free duration was 51 days, and the median survival time was 74 days. Two patients with gastric cancer survived over 200 days with resumed chemotherapy. Stent occlusion occurred in three patients; all underwent secondary placement, though salvage surgery was required due to poor clinical outcomes.

[CONCLUSIONS] Colorectal stenting provides short-term symptomatic relief in ECM-induced obstruction; however, long-term outcomes were limited, likely due to the underlying advanced malignancies. Although secondary stent placement was technically feasible, its effectiveness in recurrent obstruction was poor.