A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer
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Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer.
A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed. The primary endpoint was relief of obstruction. Secondary endpoints include technical success of the procedure, duration of hospital stay, early and long-term complications, and overall survival.
Both groups were similar in age, sex, and tumor distribution. Placement of SEMS was successful in 50/53 (94%) patients. Surgery was effective in relieving obstruction in 70/70 (100%) patients. Patients in the SEMS group have a significantly shorter median hospital stay (2 days) as compared to the surgery group (8 days) (P < 0.001). Patients with SEMS also had significantly less acute complications compared to the surgery group (8 vs. 30%, P = 0.03). The hospital mortality for the SEMS group was 0% compared to 8.5% in patients that underwent surgical decompression (P = 0.04). There was no difference in survival between the two groups (P = 0.76).
In patients with colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy when compared to surgery. In most patients with metastatic colorectal cancer and obstruction, SEMS provide a minimally invasive alternative to surgical intervention.
- Ohman U. Prognosis in patients with obstructing colorectal carcinoma. Am J Surg. 1982;143:742–747. CrossRef
- Riedl S, Wiebelt H, Bergmann U, Hermanek P Jr. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg. 1995;66:597–606.
- Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994;37:916–920. CrossRef
- Mainar A, De Gregorio Ariza MA, Tejero E, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery–results of a multicenter study. Radiology. 1999;210:65–69.
- Baron TH, Dean PA, Yates MR III, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998;47:277–286. CrossRef
- Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology. 1998;206:199–204.
- Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome—5-year review. Eur J Radiol. 2006;60(1):91–94. CrossRef
- Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007;21:2100–2104. CrossRef
- Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81:1270–1276. CrossRef
- Hennekinne-Mucci S, Tuech JJ, Brehant O, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis. 2006;21(6):538–541. CrossRef
- Fitzgerald SD, Longo WE, Daniel GL, Vernava AM III. Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified? Dis Colon Rectum. 1993;36:161–166. CrossRef
- Syn WK, Patel M, Ahmed MM. Metallic stents in large bowel obstruction: experience in a District General Hospital. Colorectal Dis. 2005;7(1):22–26. CrossRef
- Coco C, Verbo A, Manno A, et al. Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg. 2005;29(11):1458–1464. CrossRef
- Harris GJ, Senagore AJ, Lavery IC, Church JM, Fazio VW. Factors affecting survival after palliative resection of colorectal carcinoma. Colorectal Dis. 2002;4:31–35. CrossRef
- Keymling M. Colorectal stenting. Endoscopy. 2003;35:234–238. CrossRef
- Maetani I, Tada T, Ukita T, et al. Self-expandable metallic stent placement as palliative treatment of obstructed colorectal carcinoma. J Gastroenterol. 2004;39(4):334–338. CrossRef
- Baque P, Chevallier P, Karimdjee SF, et al. Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction. (French). Ann Chir. 2004;129(6–7):353–358. CrossRef
- Repici A, De CG, Luigiano C, et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc. 2008;67:77–84. CrossRef
- Dauphine CE, Tan P, Beart RW Jr, Vukasin P, Cohen H, Corman ML. Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review (Review, 33 refs). Ann Surg Oncol. 2002;9(6):574–579. CrossRef
- Baik SH, Kim NK, Cho HW, et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepatogastroenterology. 2006;53(68):183–187.
- Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum. 2002;45:401–406. CrossRef
- Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis. 2008;10:668–672. CrossRef
- Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg. 2003;90:1429–1433. CrossRef
- Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–2057. CrossRef
- Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum. 1999;42:1569–1574. CrossRef
- Carne PW, Frye JN, Robertson GM, Frizelle FA. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum. 2004;47(9):1455–1461.
- Watson AJ, Shanmugam V, Mackay I, et al. Outcomes after placement of colorectal stents. Colorectal Dis. 2005;7(1):70–73. CrossRef
- Ely CA, Arregui ME. The use of enteral stents in colonic and gastric outlet obstruction. Surg Endosc. 2003;17:89–94. CrossRef
- Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology. 2000;216(2):492–497.
- van Hooft JE, Fockens P, Marinelli AW, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008;40:184–191. CrossRef
- A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer
Digestive Diseases and Sciences
Volume 55, Issue 6 , pp 1732-1737
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Colorectal cancer
- Self-expanding metal stents
- Acute colonic obstruction
- Industry Sectors
- Author Affiliations
- 1. University of Texas Southwestern Medical School, Dallas, TX, USA
- 2. Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Road (111B1), Dallas, TX, 75216, USA