Digestive Diseases and Sciences

, Volume 55, Issue 6, pp 1732–1737 | Cite as

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

  • Roopa Vemulapalli
  • Luis F. Lara
  • Jayaprakash Sreenarasimhaiah
  • William V. Harford
  • Ali A. Siddiqui
Original Article

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 cancer Self-expanding metal stents Acute colonic obstruction Colostomy 

Notes

Grant Support

This study was funded entirely by the University of Texas Southwestern Medical School and the Dallas VA Medical Center through existing intramural funds and salary support.

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Roopa Vemulapalli
    • 1
    • 2
  • Luis F. Lara
    • 1
  • Jayaprakash Sreenarasimhaiah
    • 1
  • William V. Harford
    • 1
    • 2
  • Ali A. Siddiqui
    • 1
    • 2
  1. 1.University of Texas Southwestern Medical SchoolDallasUSA
  2. 2.Dallas Veterans Affairs Medical CenterDallasUSA

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