A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer
- Roopa VemulapalliAffiliated withUniversity of Texas Southwestern Medical SchoolDallas Veterans Affairs Medical Center
- , Luis F. LaraAffiliated withUniversity of Texas Southwestern Medical School
- , Jayaprakash SreenarasimhaiahAffiliated withUniversity of Texas Southwestern Medical School
- , William V. HarfordAffiliated withUniversity of Texas Southwestern Medical SchoolDallas Veterans Affairs Medical Center
- , Ali A. SiddiquiAffiliated withUniversity of Texas Southwestern Medical SchoolDallas Veterans Affairs Medical Center Email author
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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.
KeywordsColorectal cancer Self-expanding metal stents Acute colonic obstruction Colostomy
- A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer
Digestive Diseases and Sciences
Volume 55, Issue 6 , pp 1732-1737
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- Online ISSN
- Springer US
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- Colorectal cancer
- Self-expanding metal stents
- Acute colonic obstruction
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- 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