Self-expandable metal stent (SEMS) placement for malignant colonic obstruction in palliative patients:...

Self-expandable metal stents (SEMS) are recommended as a first-line treatment for malignant colonic obstruction in palliative patients. However, published outcomes remain controversial. This study aimed to evaluate the morbidity associated with SEMS placement in patients with tumor-related colonic obstruction in a palliative setting. Secondary objectives included long-term outcomes and the impact on subsequent oncological treatment.

A retrospective study was conducted on 146 consecutive palliative oncological patients treated at a tertiary center between 2008 and 2023. Patients were categorized into three groups based on the cause of palliation: unresectable stage IV colon cancer (Group I), colon cancer with comorbidities and poor performance status (Group II), and extrinsic compression from extracolonic malignancies (Group III).

Clinical resolution of obstruction was achieved in > 80% of patients, with significant differences among groups (88% in Group I, 79% in Group II, and 59% in Group III; p = 0.009). Early morbidity occurred in 38% of cases and severe complications (≥ Clavien-Dindo III) in 31%. Morbidity was more frequent in Group III (65%). Thirty-day mortality was 15%. Only 12% of patients resumed chemotherapy after SEMS placement, with a median delay of 34 days. Median overall survival after SEMS placement was 4 months. Over 95% of patients died because of disease progression.

SEMS placement in palliative patients is effective in relieving obstruction but carries a high risk of complications, especially in extracolonic malignancies. Less than a third of patients continue oncological treatment after stenting, highlighting the need for careful patient selection.