Patients with large bowel obstruction of malignant origin often are quite ill at presentation, and urgent surgery—often in the form of decompressive colostomy—carries high morbidity and mortality rates. An alternative to emergency surgery in this setting is to install a colonic stent. This study reviewed the records of 35 patients with various gynecologic cancers who had colorectal stent placement in the years 2001–2006 with the goal of relieving large bowel obstruction. Recurrent ovarian cancer was present in 25 patients, recurrent endometrial cancer in seven, primary peritoneal carcinoma in two, and recurrent cervical cancer in one. The median age at the time of stent placement was 54 years. The median length of bowel obstruction was 6.5 cm. Six of the patients had a 1- to 2-mm lumen, while the other 29 had complete obstruction and required balloon dilation before deploying the stent.
Successful stent placement, defined as decompression followed immediately by the passage of flatus and stool, was achieved inn 27 patients, 77% of those in the study. One-third of these patients had additional surgery to relieve obstruction, most often colostomy or drainage gastrotomy. When stent placement failed, a nontraversable stricture and angulation of the bowel were responsible. Five of 8 patients in whom the procedure failed required colonoscopy, and three required gastrotomy. When stent placement succeeded, the median survival time after the procedure was 7.7 months, compared to 1.9 months when it failed; this difference was not statistically significant. The median hospital stay for successfully managed patients was 15 days.
Placing a colonic stent is a worthwhile option for patients having large bowel obstruction caused by recurrent gynecologic cancer; it may preclude the need for major surgery.