Oncological Safety of Flexible Rectal Stent Insertion in Obstructive Colorectal Cancer: Short Term Result

ABSTRACT

PURPOSE: Flexible rectal stent for obstructive colorectal cancer has an advantage of elective one stage operation after decompression. But, forceful expansion of stent may increase the possibility of tumor cell dissemination through lymph nodes and blood vessels. We studied the oncological safety of stent insertion in obstructive colorectal cancer. METHODS: From June 1996 to August 2001, the patients with stent insertion for obstructive colorectal cancer at Samsung Medical Center were retrospectively evaluated. Seventy- one patients had stent insertion for palliation or curative resection. Among these patients 15 patients underwent curative surgery after stent insertion (stent group). During the same period 25 patients underwent multi-staged operation after the decompressing colostomy or Hartman operation. (staged operation group). Statistical methods such as Fisher's exact test, 2-test, Kaplan-Meier method were used. RESULTS: There was no significant difference between two groups in terms of age, gender, tumor location, and stage. The median follow-up period was 21 months in stent insertion group and 29 months in staged operation group. Overall recurrence rate was 33.3% in stent insertion group and 32.0% in staged operation group. The 5-year survival rate in stent insertion group was higher than in staged operation group (75.8% vs. 48.3%). But there was no statistical significance (P>0.05 ). Disease free survival was 22.4 (6~51) months in stent insertion group and 27.8 (5~71) months in staged operation group. There was no significant difference either. CONCLUSIONS: There was no significant difference between two groups in survival rate, recurrence rate in short term result. Flexible rectal stent insertion can be considered as oncologically safe and useful treatment of obstructive colorectal cancer. But we think long term follow up and much more cases will be necessary to make a conclusion more definitively.