Digestive Diseases and Sciences

, Volume 55, Issue 6, pp 1732–1737

A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer

Authors

  • Roopa Vemulapalli
    • University of Texas Southwestern Medical School
    • Dallas Veterans Affairs Medical Center
  • Luis F. Lara
    • University of Texas Southwestern Medical School
  • Jayaprakash Sreenarasimhaiah
    • University of Texas Southwestern Medical School
  • William V. Harford
    • University of Texas Southwestern Medical School
    • Dallas Veterans Affairs Medical Center
    • University of Texas Southwestern Medical School
    • Dallas Veterans Affairs Medical Center
Original Article

DOI: 10.1007/s10620-009-0945-7

Cite this article as:
Vemulapalli, R., Lara, L.F., Sreenarasimhaiah, J. et al. Dig Dis Sci (2010) 55: 1732. doi:10.1007/s10620-009-0945-7

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Colorectal cancerSelf-expanding metal stentsAcute colonic obstructionColostomy

Copyright information

© Springer Science+Business Media, LLC 2009