Complication Rate of Palliative Colonic Stenting for Metastatic Colorectal Cancer
Bibliographic record
Abstract
Introduction: Some patient with metastatic colorectal cancer present colonic obstruction by their primary tumor. Palliative colonic stenting is associated with risks of colonic perforation, death and risk is probably increased with anti-VEGF. We reviewed our procedures and complications to confirm benefit with acceptable risks in our local population. Methods: We reviewed the files of all patients with colonic stenting with self-expandable metal stent (SEMS) between January 2005 and March 2014. Stenting of benign stenosis or bridge to surgery were excluded. Results: Colonic stents were used as palliation in 128 patients; 127 had metastatic colorectal cancer and 1 had locally advanced non-resectable sigmoid cancer. Our population comprise 89 women and 39 men (70|30%) with mean age of 76 (43 to 93 year-old). 31 (24%) patients were on chemotherapy before the procedure. Bevacizumab was utilised in a total of 8 patients.The procedure was considered technically successful in 120 (94%). Early major complications (≤ 7 days) were stent dysfunction 1/120, stent migration 3/120 and perforation 4/120. Within those, 3 patients recovered with medical treatment and, one developed overt haemorrhage and died in the week following urgent hemicolectomy. The one patient with early stent dysfunction had balloon dilatation and perforation ensued. The three patients with early stent migration had balloon dilation and deployment of a second stent, colonic perforation was recorded in all three with subsequent death. Total early complication rate was 7% (8/120) and early death rate was 4% (5/128). Reported late complications (> 7 days) were stent dysfunction 13/120 (11%) and no migration or perforation occurred. The perforation risk associated with stricture dilatation was 44% (4 early perforations in 9 balloon dilatations, all were fatal). The perforation rate with anti-VEGF was 63% (5 perforations in 8 patients on anti-VEGF) with 50% mortality (4/8). The perforation in anti-VEGF plus balloon dilatation is 100%(4/4) and is always fatal. Conclusion: The early major complication rate is 7% with a 4% death. The perforation and mortality of stent installation are marked in the group of bevacizumab, with balloon dilation and when these two factors were associated; with a 100% perforation and mortality. This outlines the importance of patient selection and appropriate intervention for optimal quality of care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".