P-260 - Complication rate of palliative colonic stenting for metastatic colorectal cancer

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Complications of Treatment
Palliative Care
Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter H. Bernard
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors H. Bernard1, G. Hassan1, A. Beaudoin1, J.-. Baillargeon1, P. Germain2
  • 1Université de Sherbrooke, Sherbrooke/CA
  • 2Centre Hospitalier Honoré-Mercier, Saint-Hyacinthe/CA

Abstract

Introduction

Metastatic colorectal cancer patients can present colonic obstruction by their primary tumor. There are benefits of palliative colonic stenting to relieve obstruction and allow safer palliative chemotherapy. However this procedure is associated with risks. We reviewed our procedures and complication rates to confirm benefits with acceptable risks in our local population.

Methods

We reviewed the files of all patients with palliative colonic stenting with self-expandable metal stent (SEMS) between January 2005 and March 2014. Indications, stent characteristics, success rates, salvage therapy, early and late complications, concurrent therapy and death were collected.

Results

Colonic stents were used as palliation in 128 patients; 89 women and 39 men (70|30%) with mean age of 76 (43 to 93 year-old). 31 (24%) patients were on chemotherapy before the procedure and chemotherapy was stopped after stent installation in 22 patients and start in 7 others for a total of 16 on chemotherapy after stent installation (13%).

Bevacizumab was utilised in a total of 8 patients (6%); 3 before, 3 before and after, and in 2 after the stent installation.

The procedure was considered technically successful in 120 (94%). Dysfunction or migration developed in four for an early clinical success of 116/128 (91%).

Early complications (≤ 7 days) were stent dysfunction 1/120 (1%), stent migration in 3/120 (3%) and spontaneous perforation 4/120 (3%). Within those, 3 patients recovered with medical treatment and, one died. The one patient with early stent dysfunction had balloon dilatation and perforation occurred. The three patients with early stent migration had balloon dilation and deployment of a second stent, colic perforation was recorded in all three. The colic perforation of these four patients was fatal. Total early complication rate was 7% (8/120) and early death rate was 4% (5/128). Five of these 8 perforations occurred in patients receiving anti-Vascular Endothelial Growth Factor.

Late complications (> 7 days) were stent dysfunction 13/120 (11%) and no migration or perforation occurred.

The perforation risk associated with stricture dilatation was 44% (4 early perforations in 9 balloon dilatations, all were fatal). The perforation rate with anti-VEGF was 63% (5 perforations in 8 patients on anti-VEGF) with 50% mortality (4/8), one spontaneous perforation and four associated with balloon dilatation.

The perforation in the later group (anti-VEGF plus balloon dilatation) is 100%(4/4) and is always fatal.

Conclusion

We confirmed a clinical success of 91%. Early complication rate is 7% with a 4% death and are higher than previously reported. Late complication rate is 11% for a 17.5% total complication, comparable to other studies. The perforation and mortality of stent installation are marked in the group of bevacizumab (63 and 50%), with the use of balloon dilation (44 and 44%) and more when these two factors were associated; with a 100% perforation and mortality. This study confirmed that SEMS should not be used with anti-VEGF, stricture dilation should be avoided and strongly discouraged in patients who were or will be treated with anti-VEGF.