Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis

  • D. Xinopoulos
  • D Dimitroulopoulos
  • T. Theodosopoulos
  • K. Tsamakidis
  • G. Bitsakou
  • G. Plataniotis
  • M. Gontikakis
  • M. Kontis
  • I. Paraskevas
  • P. Vassilobpoulos
  • E. Paraskevas
Original article


Background: The aim of the present study was to compare the efficacy, safety, and cost of endoscopic palliative treatment with selfexpanding metallic stents with that of stoma creation in the management of inoperable malignant colonic obstructions. Methods: A total of 30 patients with inoperable malignant partial obstruction (due to metastases, hemodynamic instability, or pulmonary instability) in the left colon unsing from colorectal or ovarian cancer were included in the study. Fifteen were randomized to undergo palliative metallic colonic stent placement and 15 to undergo stoma creation. The efficacy and safety of the two methods was compared. A cost-effectiveness analysis was also performed, including the cost of postinterventional care. Results: Stents were placed successfully in 14 of 15 patients. In one patient with obstruction of a tortuous rectosigmoid flexure colon, stenting was not possible; this patient was excluded from the study. During the follow-up period, a moderate, nonocclusive ingrowth of tumor into the stent lumen was observed in six patients; they were all treated with internal laser ablation. The cost-effectiveness analysis showed that although the stoma creation procedure was less expensive, the total difference in average costs for the two methods was 6.9% (132 Euros). Conclusions: Self-expanding metallic stent placement is a palliative alternative to colostomy for patients with inoperable malignant colonic strictures. This treatment option provides a better quality of life for the patient, without the psychological repercussions of a colostomy, and it appears to be cost-effective.


Self-expanding metal stents Colon cancer Palliative treatment Cost-effectiveness analysis Colostomy Cancer 


  1. 1.
    Anderson, JH, Hole, D, Mc Ardle, CS 1992Elective versus emergency surgery for patients with colorectal cancer.Br J Surg79706709PubMedGoogle Scholar
  2. 2.
    Aston, NO, Owen, WJ, Irving, JD 1989Endoscopic balloon dilatation of colonic anastomotic strictures.Br J Surg76780782PubMedGoogle Scholar
  3. 3.
    Baron, TH, Dean, PA, Yates, MR,  et al. 1998Expandable metal stents for the treatment of colonic obstruction: technical outcomes.Gastrointest Endosc47277285PubMedGoogle Scholar
  4. 4.
    Bashir, RM, Fleischer, DE, Stahl, TJ,  et al. 1996Self-expandable nitinol coil stent for management of colonic obstruction due to a malignant anastomotic stricture.Gastrointest Endosc44497501PubMedGoogle Scholar
  5. 5.
    Bengtsson, G, Carlsson, G, Hafstrom, L,  et al. 1981Natural history of patients with untreated liver metastases from colorectal cancer.Am J Surg141586589PubMedGoogle Scholar
  6. 6.
    Binelli, C, Chautard, D, Georgeac, C,  et al. 1995Stenose du rectum secondaire a un envahissement d’un adenocarcinome de prostate: a propos de trois observations.J Chir132137141Google Scholar
  7. 7.
    Binkert, CA, Ledermann, H, Jost, R,  et al. 1998Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents. A preliminary report.Radiology206199204PubMedGoogle Scholar
  8. 8.
    Camúňez, F, Echenagusia, A, Simó, G,  et al. 2000Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation.Radiology216492497PubMedGoogle Scholar
  9. 9.
    Canon, CL, Baron, TH, Morgan, DE,  et al. 1997Treatment of colonic obstruction with expandable metal stents: radiological features.AJR168199205PubMedGoogle Scholar
  10. 10.
    Davidson, R, Sweeney, WB 1998Endoluminal stenting for benign colonic obstruction.Surg Endosc12353354CrossRefPubMedGoogle Scholar
  11. 11.
    Diaz, LP, Pabon, IP, Lobato, RF,  et al. 1999Palliative treatment of malignant colorectal strictures with metallic stents.Cardiovasc Intervent Radiol222936PubMedGoogle Scholar
  12. 12.
    Gandrup, P, Lund, L, Balslev, I 1992Surgical treatment of acute malignant large bowel obstruction.Eur J Surg158427430PubMedGoogle Scholar
  13. 13.
    Golighrer, I, Hafner, CD 1957The treatment of acute obstruction or perforation with carcinoma of the colon and rectum.Br J Surg450270274Google Scholar
  14. 14.
    Hoekstra, HJ, Varschueren, RCJ, Oldhoff, J,  et al. 1985Palliative and curative electrocoagulation for rectal cancer: Experience and results.Cancer55210213PubMedGoogle Scholar
  15. 15.
    Keymling, M 2003Colorectal stenting.Endoscopy35234238CrossRefPubMedGoogle Scholar
  16. 16.
    Knöpfle, E, Mayer, E, Wamser, G,  et al. 2001Illeus beim colorectalen Carcinom. Präoperative Implantation eines Metallgitterstents und frühelective Operation als Alternative zur notfallmässigen Operation.Chirurg7211371143CrossRefPubMedGoogle Scholar
  17. 17.
    Landis, SH, Murray, T, Bolden, S,  et al. 1998Cancer statistics 1998.CA Cancer J Clin48629PubMedGoogle Scholar
  18. 18.
    Law, WL, Chu, KW, Ho, JW,  et al. 2000Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies.Dis Colon Rectum4315221527PubMedGoogle Scholar
  19. 19.
    Liberman, H, Adams, DR, Blatchford, GJ,  et al. 2000Clinical use of the self-expanding metallic stent in the management of colorectal cancer.Am J Surg180407412PubMedGoogle Scholar
  20. 20.
    Lo, SK 1999Metallic stenting for colorectal obstruction.Gastrointest Endosc Clin N Am9459477PubMedGoogle Scholar
  21. 21.
    Lofler, I, Hafner, CD 1964Survival rate in obstructing carcinoma of the colon.Arch Surg89716718PubMedGoogle Scholar
  22. 22.
    Lopez, CM, Martinez, JMR, Cebrian, ET,  et al. 2001Treatment of left colon neoplastic obstruction by placement of self-expandable stents.Rev Esp Enferm Dig93232237Google Scholar
  23. 23.
    Mainar, A, De Gregorio Ariza, MA, Tejero, E,  et al. 1999Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery—results of a multicenter study.Radiology2106569PubMedGoogle Scholar
  24. 24.
    Mauro, MA, Koehler, RE, Baron, TH 2000Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.Radiology215659669PubMedGoogle Scholar
  25. 25.
    McIntyre, R, Reinbach, D, Cuschieri, RJ 1997Emergency abdominal surgery in the elderly.J R Coll Surg Edinb42173178PubMedGoogle Scholar
  26. 26.
    Nagy, AG 1990Palliative treatment of advanced colorectal carcinoma with the YAG laser.Can J Surg33261264PubMedGoogle Scholar
  27. 27.
    Oz, MC, Forde, KA 1990Endoscopic alternatives in the management of colonic strictures.Surgery108513519PubMedGoogle Scholar
  28. 28.
    Patrice, T, Foultier, MT, Yactayo, S,  et al. 1990Endoscopic photodynamic therapy with hematoporphyrin derivate for primary treatment of gastrointestinal neoplasms in inoperable patients.Dig Dis Sci35545552PubMedGoogle Scholar
  29. 29.
    Regland, JJ, Londe, AM, Spratt, JS 1971Correlation on the prognosis of obstructing colorectal carcinoma with clinical and pathologic variables.Am J Surg121552556PubMedGoogle Scholar
  30. 30.
    Repici, A, Reggio, D, De Angelis, C,  et al. 2000Covered metal stents for management of inoperable malignant colorectal strictures.Gastrointest Endosc52735740CrossRefPubMedGoogle Scholar
  31. 31.
    Saida, Y, Sumiyama, Y, Nagao, J,  et al. 1996Stent endoprosthesis for obstructing colorectal cancers.Dis Colon Rectum39552555PubMedGoogle Scholar
  32. 32.
    Serpell, JW, McDermot, FT, Katrivessis, H,  et al. 1989Carcinomas de colon que provocan oclusion intestinal.Br J Surg (Spanish ed)2549554Google Scholar
  33. 33.
    Seymour, K, Johnson, R, Marsh, R,  et al. 2002Palliative stenting of malignant large bowel obstruction.Colored Dis4240245CrossRefGoogle Scholar
  34. 34.
    Tack, J, Gevers, AM, Rutgeerts, P 1998Self-expandable metallic stents in the palliation of rectosigmoid carcinoma: a follow-up study.Gastrointest Endosc48267271Google Scholar
  35. 35.
    Turegano-Fuentes, F, Echenagusia-Belda, A, Simo-Muerza, G,  et al. 1998Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.Br J Surg85232235CrossRefPubMedGoogle Scholar
  36. 36.
    Xinopoulos, D, Dimitroulopoulos, D, Tsamakidis, K,  et al. 2002Treatment of malignant colonic obstructions with metal stents and laser.Hepatogastroenterology49359362PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • D. Xinopoulos
    • 1
  • D Dimitroulopoulos
    • 1
  • T. Theodosopoulos
    • 2
  • K. Tsamakidis
    • 1
  • G. Bitsakou
    • 2
  • G. Plataniotis
    • 2
  • M. Gontikakis
    • 2
  • M. Kontis
    • 3
  • I. Paraskevas
    • 4
  • P. Vassilobpoulos
    • 2
  • E. Paraskevas
    • 1
  1. 1.Gastroenterology UnitSaint Savvas Cancer Hospital, Parnassou 35, 152 34, AthensGreece
  2. 2.First Surgical DepartmentSaint Savvas Cancer Hospital, Parnassou 35, 152 34, AthensGreece
  3. 3.Economics and Statistics DepartmentSaint Savvas Cancer Hospital, Parnassou 35, 152 34, AthensGreece
  4. 4.Cass Business School, Faculty of Finance, City University, LondonUnited Kingdom

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