Endoscopic stent in malignant colonic obstruction: the risk of tumor seeding^☆

Prótese endoscópica no carcinoma do cólon em obstrução: risco dedisseminação tumoral

Introduction  Malignant colonic occlusion is traditionally considered a surgical emergency. With the development of endoscopic techniques, metallic stents have emerged to ensure the colonic patency in nonsurgical candidates and, more recently, as a temporary measure until elective resection surgery is possible.

Materials and methods  The research was conducted in PubMed and collected a total of 46 articles, including cross-references.

Results  Ideally, intestinal occlusion should be resolved through tumor's primary resection with direct anastomosis. To avoid dehiscence of the anastomosis, tumor's resection may be performed with Hartmann's procedure. Metal stents are an alternative to emergency surgery and show excellent results in reliving colonic obstruction. However, they may have serious complications related to colonic perforation, migration and tumor dissemination.

Discussion and conclusion  Observational studies and clinical trials show discrepant results. Metal stents are increasingly accepted in palliative care but are not yet recommended as a bridge to curative surgery. Treatment should be individualized, according to surgical risk and the probability of endoscopic complications.

Keywords
Malignant colonic obstruction; Emergency surgery; Colonic endoscopic stent; Tumor seeding