Abstract
Background
Palliative surgery for the treatment of incurable obstructive colorectal carcinoma is associated with a considerable perioperative morbidity and mortality but no substantial improvement of the prognosis. The aim of the present study was to study the effectiveness of colorectal stenting compared with palliative surgery in incurable obstructive colorectal carcinoma.
Patients and Methods
From April 1999 to April 2005, data of consecutive patients with incurable stenosing colorectal carcinoma, either treated with stent implantation or palliative surgical intervention, were prospectively recorded with respect to age, sex, tumor location (including metastases), ASA-score, peri-interventional morbidity, mortality, rates of complications, and re-interventions as well as survival.
Results
Of 40 patients, 38 (95%) were successfully treated with a stent. Two patients (5%) underwent surgical intervention after stent dislocation. In contrast, 38 patients primarily underwent palliative surgical intervention. Stent patients were significantly older (P = 0.020), had a higher ASA-score (P = 0.012), and had more frequently distant metastases (P = 0.011). After successful stent implantation, no early complications were observed, but late complications occurred in 11 subjects (29%). Following palliative surgical intervention, postoperative complications occurred in 12 individuals (32%) . Postoperative mortality was 5% in the surgery group, whereas no patient died following stent implantation. There was no significant differences in the survival of both groups (9.9 vs. 7.8 months, respectively; log rank: 0.506).
Conclusions
Palliative treatment of incurable obstructive colorectal carcinoma using stents is an effective and suitable alternative to palliative surgery with no negative impact on the survival but less peri-interventional morbidity and mortality as well as comparable overall morbidity.
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References
Carne PW, Frye JN, Robertson GM, et al. Stents or operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 2004;47:1455–1461
Fiori E, Lamazza A, De Cesare A, et al. Palliative management of malignant rectosigmoidal obstruction. Colostoma vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 2004;24:265–268
Johnson R, Marsh R, Corson J, et al. A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer. Ann R Coll Surg Engl 2004;86:99–103
Joffey J, Gordon PH. Palliative resection for colorectal carcinoma. Dis Colon Rectum 1981;24:355–360
Wabeno HJ, Semoglou C, Attiyeh F, et al. Surgical management of patients with primary operable colorectal cancers and synchronous liver metastasis. Am J Surg 1978;135:81–85
Rosen SA, Buell JF, Yoshida A, et al. Initial presentation with stage IV colorectal cancer. How aggressive should we be? Arch Surg 2000;135:530–535
Makela J, Haukipuro K, Laitinen S, et al. Palliative operations for colorectal cancer. Dis Colon Rectum 1990;33:846–850
Liu SK, Church JM, Lavery IC, et al. Operations in patients with incurable colon cancer — is it worthwhile? Dis Colon Rectum 1997;40:11–14
Scoggins CR, Meszoely IM, Blanke CD, et al. Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 1999;6:651–657
Ruo L, Gougoutas C, Paty PB, et al. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 2003;196:722–728
Gastinger I, Marusch F, Koch A, et al. Hartmann’s procedure indication in colorectal carcinoma. Chirurg 2004;75:1191–1196
De Gregorio MA, Mainar A, Tejero E, et al. Acute colorectal obstruction: stent placement for palliative treatment—results of a multicenter study. Radiology 1998;209:117–120
Bhardwaj R, Parker MC. Palliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis 2003;5:518–521
Aviv RI, Shyamalan G, Watkinson A, et al. Radiological palliation of malignant colonic obstruction. Clinical Radiol 2002;57:347–351
Suzuki N, Sauders BP, Thomas-Gibson S, et al. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 2004;47:1201–1207
Law WL, Choi HK, Lee YM, et al. Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: Prospective evaluation of outcomes. Dis Colon Rectum 2004;47:39–43
Khot UP, Lang AW, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096–1102
Meisner S, Hensler M, Knop FK, et al. Self-expanding metal stents for colonic obstruction: Experiences from 104 procedures in a single center. Dis Colon Rectum 2004;47:444–450
Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions ? Results of a study and cost-effectiveness analysis. Surg Endosc 2004;18:421–426
Seymour K, Johnson R, Marsh R, et al. Palliative stenting of malignant large bowel obstruction. Colorectal Dis 2002;4:240–245
Marusch F, Koch A, Schmidt U, et al. Importance of rectal extirpation for the therapy concept of low rectal cancers. Chirurg 2003;74:341–351
Marusch F, Koch A, Schmidt U, et al. "Colon-/rectal carcinoma" prospective studies as comprehensive surgical quality assurance. Chirurg 2002;73:138–145
Fazio VW. Indications and surgical alternatives for palliation of rectal cancer. J Gastrointest Surg 2004;8:262–265
Marusch F, Koch A, Schmidt U, et al. Impact of age on the short-term postoperative outcome of patients undergoing surgery for colorectal carcinoma. Int J Colorectal Dis 2002;17:177–184
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Ptok, H., Marusch, F., Steinert, R. et al. Incurable Stenosing Colorectal Carcinoma: Endoscopic Stent Implantation or Palliative Surgery?. World J. Surg. 30, 1481–1487 (2006). https://doi.org/10.1007/s00268-005-0513-z
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DOI: https://doi.org/10.1007/s00268-005-0513-z