Lee YJ, et al. - This trial entailed the analysis of the clinical outcomes of colonic perforation and factors linked to its occurrence in patients who were receiving self-expanding metal stents (SEMSs) for malignant colorectal obstruction. It was determined that the perforation-related 30-day mortality rate was 23.8%. Data shed light on a prominent connection between older age and sigmoid colonic location with the occurrence of early perforation. On the other hand, flexure location and absence of peritoneal carcinomatosis exhibited a correlation with delayed perforation.

Methods

• The scheme of this research was a retrospective review of cases.
• An examination was conducted of 474 patients with malignant colorectal obstruction who received endoscopic SEMS insertion from April 2004 to May 2011 in the Severance and Gangnam Severance Hospital.
• A scrutiny was performed of the early perforation, defined as perforation occurring within 2 weeks, in bridge-to-surgery (n=164) and palliative stent placement patient groups (n=310).
• Data analysis was carried out with regard to delayed perforation from the palliative stent placement group alone.

Results

• It was found that the technical and clinical success rates were 90.5% and 81.0%, respectively.
• The occurrence of early and delayed perforations was noted in 2.7% (13/474) and 2.7% (8/301) of the patients, respectively.
• A total of 14 (66.7%) received emergency surgery and 5 (23.8%) died within 30 days after perforation among 21 patients with perforation.
• In terms of the perforation-related factors, age of ≥70 years (odd ratio [OR], 3.276; 95% confidence interval [CI], 1.041-10.309) and sigmoid colonic location (OR, 7.706; 95% CI, 1.681-35.317) illustrated an independent correlation with the occurrence of early perforation.
• A prominent link was unveiled between stent location in the flexure (hazard ratio [HR], 17.573; 95% CI, 2.004-154.093) and absence of peritoneal carcinomatosis (HR, 6.139; 95% CI, 1.150-32.776) with delayed perforation.