Professor Special Lecture: 161st Regular Meeting of the Medical Society of Toho University A Review Historical Evolution, Current Status, and Future Prospects of Treatment for Obstructive Colorectal Cancer: Colonic Stent

Colorectal obstruction, a common complication in colorectal cancer, often requires emergency surgery.Historical treatments including colostomy, three-staged resection, and the Hartmann operation had complications and high mortality rates.In 1965, a complex one-staged procedure involving subtotal colon resection and lavage was introduced but had limited adoption.Transanal decompression tubes offered relief but had limitations.Self-expandable metallic stents revolutionized treatment in the 1990s.Colonic stents improved the quality of life of patients, allowing normal eating habits and early discharge.Japan initially had limited stent use but approved WallFlexTM and Niti-STM stents.The Japan Colonic Stent Safe Procedure Research Group provided guidelines and conducted studies.The research group developed the Colorectal Obstruction Scoring System to assess stent indications and treatment effectiveness.Colonic stents are mainly used for malignant colorectal stenosis in Japan, including rectal stenosis post-surgery, palliative treatment, and as a bridge to surgery.Ongoing trials aim to establish evidence for stents as a bridge to surgery.Future prospects include stents for benign stenosis and improved design with reduced migration and removability.Researchers are developing absorbable or biodegradable stents and exploring drug-eluting and radioactive stents for preventing restenosis and controlling malignant stenosis.Studies on chemotherapy after colorectal stenting aim to improve high-risk cancer prognosis.I would like to conclude by emphasizing the need for safe placement of colonic stents and refer readers to the Mini-Guidelines provided by the Colorectal Stent Safety Procedures Research Group for reference.