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



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.


Colorectal cancer Self-expanding metal stents Acute colonic obstruction Colostomy 


  1. 1.
    Ohman U. Prognosis in patients with obstructing colorectal carcinoma. Am J Surg. 1982;143:742–747.CrossRefPubMedGoogle Scholar
  2. 2.
    Riedl S, Wiebelt H, Bergmann U, Hermanek P Jr. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg. 1995;66:597–606.PubMedGoogle Scholar
  3. 3.
    Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994;37:916–920.CrossRefPubMedGoogle Scholar
  4. 4.
    Mainar A, De Gregorio Ariza MA, Tejero E, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery–results of a multicenter study. Radiology. 1999;210:65–69.PubMedGoogle Scholar
  5. 5.
    Baron TH, Dean PA, Yates MR III, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998;47:277–286.CrossRefPubMedGoogle Scholar
  6. 6.
    Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology. 1998;206:199–204.PubMedGoogle Scholar
  7. 7.
    Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome—5-year review. Eur J Radiol. 2006;60(1):91–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007;21:2100–2104.CrossRefPubMedGoogle Scholar
  9. 9.
    Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81:1270–1276.CrossRefPubMedGoogle Scholar
  10. 10.
    Hennekinne-Mucci S, Tuech JJ, Brehant O, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis. 2006;21(6):538–541.CrossRefPubMedGoogle Scholar
  11. 11.
    Fitzgerald SD, Longo WE, Daniel GL, Vernava AM III. Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified? Dis Colon Rectum. 1993;36:161–166.CrossRefPubMedGoogle Scholar
  12. 12.
    Syn WK, Patel M, Ahmed MM. Metallic stents in large bowel obstruction: experience in a District General Hospital. Colorectal Dis. 2005;7(1):22–26.CrossRefPubMedGoogle Scholar
  13. 13.
    Coco C, Verbo A, Manno A, et al. Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg. 2005;29(11):1458–1464.CrossRefPubMedGoogle Scholar
  14. 14.
    Harris GJ, Senagore AJ, Lavery IC, Church JM, Fazio VW. Factors affecting survival after palliative resection of colorectal carcinoma. Colorectal Dis. 2002;4:31–35.CrossRefPubMedGoogle Scholar
  15. 15.
    Keymling M. Colorectal stenting. Endoscopy. 2003;35:234–238.CrossRefPubMedGoogle Scholar
  16. 16.
    Maetani I, Tada T, Ukita T, et al. Self-expandable metallic stent placement as palliative treatment of obstructed colorectal carcinoma. J Gastroenterol. 2004;39(4):334–338.CrossRefPubMedGoogle Scholar
  17. 17.
    Baque P, Chevallier P, Karimdjee SF, et al. Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction. (French). Ann Chir. 2004;129(6–7):353–358.CrossRefPubMedGoogle Scholar
  18. 18.
    Repici A, De CG, Luigiano C, et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc. 2008;67:77–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Dauphine CE, Tan P, Beart RW Jr, Vukasin P, Cohen H, Corman ML. Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review (Review, 33 refs). Ann Surg Oncol. 2002;9(6):574–579.CrossRefPubMedGoogle Scholar
  20. 20.
    Baik SH, Kim NK, Cho HW, et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepatogastroenterology. 2006;53(68):183–187.PubMedGoogle Scholar
  21. 21.
    Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum. 2002;45:401–406.CrossRefPubMedGoogle Scholar
  22. 22.
    Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis. 2008;10:668–672.CrossRefPubMedGoogle Scholar
  23. 23.
    Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg. 2003;90:1429–1433.CrossRefPubMedGoogle Scholar
  24. 24.
    Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–2057.CrossRefPubMedGoogle Scholar
  25. 25.
    Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum. 1999;42:1569–1574.CrossRefPubMedGoogle Scholar
  26. 26.
    Carne PW, Frye JN, Robertson GM, Frizelle FA. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum. 2004;47(9):1455–1461.PubMedGoogle Scholar
  27. 27.
    Watson AJ, Shanmugam V, Mackay I, et al. Outcomes after placement of colorectal stents. Colorectal Dis. 2005;7(1):70–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Ely CA, Arregui ME. The use of enteral stents in colonic and gastric outlet obstruction. Surg Endosc. 2003;17:89–94.CrossRefPubMedGoogle Scholar
  29. 29.
    Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology. 2000;216(2):492–497.PubMedGoogle Scholar
  30. 30.
    van Hooft JE, Fockens P, Marinelli AW, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008;40:184–191.CrossRefPubMedGoogle Scholar

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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