Use of self-expanding stent in the palliation of rectal cancer recurrences

BACKGROUND: Patients with nonresectable rectal cancer recurrences and elderly high risk patients are currently given a colostomy as a palliative therapy. To improve the quality of life in these patients, we inserted a self-expanding metal stent to relieve the symptoms of obstruction caused by a rectal cancer recurrence. METHODS: Three patients (two male, one female; ages 61, 69, and 59), all suffering from a rectal cancer pelvic recurrence and diffuse metastases, had a stent inserted. Using fluoroscopic and endoscopic control, a metal guidewire was passed through the obstruction. A mild dilatation of the stenosis was carried out before positioning of the expandable metal stent. RESULTS: The procedure was successful at the first attempt in all the patients, and stool evacuation was immediate. Patients complained of rectal tenesmus during the first 48 h, which was treated with nonsteroid anti-inflammatory drugs. However, there were no serious complications related to the procedure. Regular endoscopic and clinical follow-up were carried out. No patient had any evidence of recurrent obstruction. CONCLUSION: In cases of inoperable rectal cancer recurrence, the placement of self-expanding metal stents is technically feasible and safe, and it avoids a permanent colostomy.