Stent or surgery for incurable obstructive colorectal cancer: an individualized decisión

  • Javier Súarez
  • Javier Jiménez
  • Ruth Vera
  • Antonio Tarifa
  • Enrique Balén
  • Virginia Arrazubi
  • Juan Vila
  • Jose M. Lera
Original Article

Abstract

Introduction

In the setting of stage-IV obstructive colorectal cancer, self-expanding metallic stents (SEMS) placement and palliative surgery may be appropriate options. The aim of the present study is to evaluate the long-term results of surgery compared with stent implantation and to identify patients in whom one of these options can provide more benefit.

Materials and methods

From November 2000 to November 2008, 98 patients with incurable stage-IV colorectal cancer were treated with palliative surgery (n=53) or SEMS (n=45). Data were recorded with respect to age, gender, tumor location, carcinoembryogenic antigen, ASAclass, presence of metastatic disease in one or multiple organs, volume of liver metastases, urgency of the procedure and treatment with chemotherapy. Comparison between surgery and stent placement was performed for all group and for patients who received and did not receive chemotherapy.

Results

Both groups were comparable regarding age, ASA-class, chemotherapy treatment, tumor location and presence of metastatic disease in one or multiple organs but not in gender, rate of urgent procedures, abnormal CEA and of volume of liver metastases >25%. Survival in surgical group was significantly higher (11.9 vs 7.3 months; log-rank test, p = 0.002). SEMS group had lower early morbidity, hospital stay and stoma creation. For patients who received chemotherapy, surgery provided benefit in survival (6.8 vs 3.9 months; log-rank test, p = 0.101); in this subgroup, long-term complications from the primary tumour were more common in stented group, and time to chemotherapy was longer in the group of surgery. No differences in survival were shown in patients who did not receive chemotherapy.

Conclusion

Stent placement offers advantages regarding early morbidity, hospital stay and stoma creation. Surgery offers a benefit in survival in patients who receive chemotherapy but not in non-candidates to chemotherapy.

Keywords

Incurable coloretal cancer Self-expanding metal stent Palliative surgery 

References

  1. 1.
    Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89(9):1096–1102CrossRefPubMedGoogle Scholar
  2. 2.
    Lo SK (1999) Metallic stenting for colorectal obstruction. Gastrointest Endosc Clin N Am 9(3):459–477PubMedGoogle Scholar
  3. 3.
    Keats AS (1978) The ASA classification of physical status—a recapitulation. Anesthesiology 49(4):233–236CrossRefPubMedGoogle Scholar
  4. 4.
    Heinemann A, Wischhusen F, Püschel K, Rogiers X (1993) Standard liver volume in the Caucasian population. Liver Transpl Surg 5(5):366–368CrossRefGoogle Scholar
  5. 5.
    Sarela AI, Guthrie JA, Seymour MT, Ride E, Guillou PJ, O’Riordain DS (2001) Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer. Br J Surg 88(10):1352–1356CrossRefPubMedGoogle Scholar
  6. 6.
    Scoggins CR, Meszoely IM, Blanke CD, Beauchamp RD, Leach SD (1999) Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 6(7):651–657CrossRefPubMedGoogle Scholar
  7. 7.
    Yun HR, Lee WY, Lee WS, Cho YB, Yun SH, Chun HK (2007) The prognostic factors of stage IV colorectal cancer and assessment of proper treatment according to the patient’s status. Int J Colorectal Dis 22(11):1301–1310CrossRefPubMedGoogle Scholar
  8. 8.
    Eisenberger A, Whelan RL, Neugut AI (2008) Survival and symptomatic benefit from palliative primary tumor resection in patients with metastatic colorectal cancer: a review. Int J Colorectal Dis 23(6):559–568CrossRefPubMedGoogle Scholar
  9. 9.
    Carne PW, Frye JN, Robertson GM, Frizelle FA (2004) Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 47(9):1455–1461PubMedGoogle Scholar
  10. 10.
    Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, Sobhani I, Tran Van Nhieu J, Delchier JC, Fagniez PL, Piedbois P, Cherqui D (2007) Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg 142(7):619–623CrossRefPubMedGoogle Scholar
  11. 11.
    Faragher IG, Chaitowitz IM, Stupart DA (2008) Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis 10(7):668–672CrossRefPubMedGoogle Scholar
  12. 12.
    Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I (2006) Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery? World J Surg 30(8):1481–1487CrossRefPubMedGoogle Scholar
  13. 13.
    Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery a palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90(11):1429–1433CrossRefPubMedGoogle Scholar
  14. 14.
    Stelzner S, Hellmich G, Koch R, Ludwig K (2005) Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol 89(4):211–217CrossRefPubMedGoogle Scholar
  15. 15.
    Kuo LJ, Leu SY, Liu MC, Jian JJ, Hongiun Cheng S, Chen CM (2003) How aggressive should we be in patients with stage IV colorectal cancer? Dis Colon Rectum 46(12):1646–1652CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Javier Súarez
    • 1
  • Javier Jiménez
    • 2
  • Ruth Vera
    • 3
  • Antonio Tarifa
    • 1
  • Enrique Balén
    • 1
  • Virginia Arrazubi
    • 3
  • Juan Vila
    • 2
  • Jose M. Lera
    • 1
  1. 1.General SurgeryHospital de NavarraPamplonaSpain
  2. 2.GastroenterologyHospital de NavarraPamplonaSpain
  3. 3.Medical OncologyHospital de NavarraPamplonaSpain

Personalised recommendations