Causes of stenting complications for malignant colorectal stenosis in patients with acute obstructive colonic obstruction

Aim. To determine the causes and incidence of intra- and postoperative complications in the placement of self-expanding metallic stents in patients with acute malignant colonic obstruction.

Materials and methods. The results of stenting in 307 patients with acute obstructive malignant colonic obstruction who underwent treatment at the S. S. Yudin City Clinical Hospital between 2018 and 2023 were analyzed.

Results. Complete clinical effect was achieved in 83.1 % of cases (n = 255) following the placement of self-expanding metallic stents. Stent-related complications were observed in 16.9 % (n = 52) of cases. These included perforation in 23 patients, incomplete stent apposition in 20 patients, stent migration in 8 cases, and irreversible intestinal ischemia due to colonic dilatation in 1 patient. Predictors of ineffective stenting included: diameter of residual lumen ≤2 mm; increased rigidity of the tumor stricture; deformation of the narrowed lumen with sharp angulation at anatomical bends; and the presence of an additional stricture. A statistically significant association between complications and the following factors was identified. Stent deployment diameter: the median and IQR in the complication-free group was 10.0 mm (interquartile range 7.6–12.0), while in the group with complications it was 8.0 mm (interquartile range 6.0–10.0) (p = 0.049; Mann–Whitney U test). Subcompensated and decompensated forms of acute colonic obstruction (95 % confidence interval (CI) 1.1–7.7; p = 0.033; Cramer’s V was 0.148). Chemotherapy: odds ratio (OR) was 2.3; 95 % CI 1.1–4.9; p = 0.035 (Pearson’s χ² test, Cramer’s V 0.120). Radiotherapy: OR 2.8; 95 % CI 1.3–17.7; p = 0.044 (Pearson’s χ² test, Cramer’s V 0.106). Cancer stage >3B: OR 2.6; 95 % CI 1.3–5.5; p = 0.008 (Pearson’s χ² test, Cramer’s V 0.151). Diameter of the proximal loop of the colon above the tumor stricture ≥80 mm: OR 1.6; 95 % CI 1.0–3.4; p = 0.05 (Pearson’s χ² test, Cramer’s V 0.100). Tumor location in the sigmoid colon: OR 1.6; 95 % CI 1.1–3.0; p = 0.049 (Pearson’s χ² test, Cramer’s V 0.101). Tumor location in the rectosigmoid colon: OR 2.9; 95 % CI 1.2–7.3; p = 0.016 (Pearson’s χ² test, Cramer’s V 0.187). Overall mortality was 7.2 % (n = 22). Stent-related mortality was reported in 15 (4.9 %) patients.

Conclusion. The placement of self-expanding metallic stents for colorectal stenting is a safe and effective approach to relieving acute obstructive malignant colonic obstruction. Potential predictors of stenting failure were identified.