Colon Cancer
Colonic obstruction devices. What about endolumenal therapy, such as laser photoablation therapy. This is an example of a proximal rectal tumor followed by laser photoablation therapy, a significant increase in lumen size can be achieved. The same downsides as with esophageal cancer, typically to achieve this effect requires multiple initial sessions and probably multiple follow-up sessions every couple of months or so. We’ve actually followed one patient who wanted this form of therapy. He’s been alive now for over two years with this approach.
As far as stent therapy, the Schneider company has now made an entro-endo prosthesis which the indications have been achieved now for colonic stenting as well as for gastroduodenal stenting. What are the approved indications? The first one, for preoperative relief of obstruction. The goal here is to place the stent across the acute obstruction that may be presenting, hoping to decompress and then cleanse the colon which will then hopefully allow a single stage procedure to be performed. The second indication is for palliative treatment. Is there a lot of data regarding this information? No, there certainly isn’t. We are beyond the case report phase but certainly not anywhere near the controlled series approach. So basically we just have a couple of reports in the literature showing individual authors series at this point.
Two series, one by an Italian group and one by Todd Baron who just joined our group at Mayo a few months ago, looking at preoperative relief of obstruction. This is, all-told, about 75 patients total. Successful placement averaged about 90% and these were lesions in the sigmoid colon, as well as the descending colon, and even transverse colon in a couple of patients. The delivery system is quite flexible. It can be maneuvered into the transverse colon if needed. The Italian group looked at patients on an attempt-to-treat basis, looking for “can the stent provide decompression and cleansing allowing for a single stage operation to occur?” and that was the case. That is, the stent allowed for that procedure to be carried out in almost two-thirds of patients.