Stent for palliation of advanced colorectal cancer

In palliation of advanced colorectal cancer, self-expanding metal stent (SEMS) can be an alternative to surgical resection for malignant obstruction proximal to the splenic flexure. SEMS is recommended as the preferred treatment for palliation of left-sided advanced malignant colonic obstruction with a high quality of evidence, except in patients (1) with a presumed long life expectancy (>1 year) and (2) treated or considered for treatment with antiangiogenic drugs (ie, bevacizumab). The validity of the recommendation that palliative stenting is contraindicated in patients with a presumed long life expectancy (>1 year) because of late stent-related complications is debatable and might be an erroneous conclusion. It is recommended that each institution should decide a clear strategy for this palliative group of long-term survivors. Understanding the risks of surgery is important for both patients and surgeons in the shared decision-making process, and it is recommended to implement a surgical risk prediction system. Patients who have undergone palliative stenting can be safely treated with chemotherapy without antiangiogenic agents. Given the high risk of colonic perforation, it is not recommended to use SEMS as palliative decompression of obstructions if a patient is being treated or considered to be treated with antiangiogenic therapy (ie, bevacizumab).