A new Mayo Clinic study has found that relieving bowel obstructions with a minimally invasive procedure to place a self-expanding metal stent in the intestine is a safe and effective therapy for colon and rectal cancer patients.
When compared with traditional management, the procedure can reduce the time patients’ spend in the hospital and offer a better quality of life. These findings are being presented today at the American College of Gastroenterology Annual Scientific Meeting in Philadelphia.
The American Cancer Society predicts that there will be more than 150,000 new cases of colon and rectal cancer in the United States this year. Up to 30 percent of those patients may develop a bowel obstruction, a blockage in the intestine that results in the inability to pass stool.
This condition requires immediate treatment to open the obstruction — either emergency surgery with a 10 percent to 30 percent mortality rate or a minimally invasive procedure to place a self-expanding metal stent in the intestine. For colon and rectal cancer patients whose cancer is inoperable, the stents are used as palliative therapy to keep the intestines functioning and avoid a major operation. For patients whose cancer can be removed surgically, the stents are temporary relief from the obstruction so the patient can be more thoroughly evaluated before surgery.
“Traditional management of patients with bowel obstructions is emergency surgery, and often, the creation of an opening in the skin, or a stoma, to allow waste to exit the body and be collected in an external bag. This is obviously not an ideal therapy for patients, as quality of life is drastically lowered,” says Todd Baron, M.D., a gastroenterologist at Mayo Clinic and an author of this study.
Dr. Baron and Aaron Small, the Mayo Clinic medical student leading the team of researchers on this study, set out to determine if the use of self-expanding metal stents is a safe and effective treatment for both palliative and preoperative patients. Their study, the largest of its kind, reviewed the records of 169 patients who were treated from 1999 to 2006 with self-expanding metal stents for relief of malignant large bowel obstruction. Of these patients, 134 were treated with palliative intent and 35 as a preoperative therapy. The stents were successfully placed in 160 patients (95 percent), and the obstruction was resolved in all but one of these patients. For the palliative group, the median time the stents remained in place to resolve obstruction was 48.5 days. While the use of self-expanding metal stents was not without complications, the research team concluded that minimally-invasive stenting can effectively relieve malignant large bowel obstruction.
“Using a minimally-invasive procedure to relieve bowel obstruction can reduce the time patients spend in the hospital, avoid the need for a stoma, and buy time for further evaluation of a patient before surgery,” says Dr. Baron. “Ultimately, it is safe, effective, and a much more patient-friendly therapy.”