Objective: Malignant large-bowel obstruction in the acute setting is considered a surgical emergency. Surgical intervention has been the standard treatment for patients presenting with large-bowel obstruction. Surgery in severely ill patients, however, can be associated with significant morbidity and mortality. Our objective was to review and update our experience with colonic stent placement for patients presenting with a large-bowel obstruction due to recurrent gynecologic malignancy.
Methods: We reviewed the records of all patients with gynecologic cancer who underwent colorectal stent placement for palliation of a large-bowel obstruction from January 2001 to October 2006.
Results: Thirty-five patients were identified--25 patients had recurrent ovarian cancer, 7 patients had recurrent endometrial cancer, 2 patients had primary peritoneal carcinoma, and 1 patient had recurrent cervical cancer. The median age at the time of stent placement was 54 years (range, 21-79). The median length of the large-bowel obstruction was 6.5 cm (range, 1-20 cm). Six patients had a lumen of 1 to 2 mm before stent placement, while 29 patients had complete obstruction and needed balloon dilatation before deployment of the stent. Twenty-seven patients (77%) underwent successful stent placement and immediate decompression at the time of colorectal stent placement. Of the patients who had successful stent placement, 9 (33%) underwent additional surgery to relieve obstruction-drainage gastrotomy, 3; colostomy, 4; and stent revision, 2. Eight patients (23%) had failed stent placement secondary to non-traversable strictures and angulation of the bowel. Of these 8 patients, 5 needed colostomy and 3 needed gastrotomy. Of the 27 patients who underwent successful stent placement, the median survival after placement was 7.7 months (95% CI, 3.19-11.9 months).
Conclusion: In the management of patients with large-bowel obstructions due to recurrent gynecologic cancer, colonic stents appear to be a reasonable option that may enable patients to avoid major surgery.