Colonic obstruction is a common complication to colorectal cancer and surgical treatment is associated with high morbidity and mortality. Stenting has emerged as an alternative to surgery. The aim of this study was to compare short-term morbidity, mortality and hospital stay between treatment with self-expandable metallic stent and emergency surgery performed at our department during a 5-year period in a non-randomized setting.
Patients with colonic obstruction due to rectal or colon cancer referred to the Endoscopic Unit or Surgical Department for insertion of a colonic stent between 1 August 2003 and 1 August 2008 were prospectively registered and followed (n = 112). A control group was identified using the hospital records of operations with the International Classification Code-10 (ICD-10) for bowel obstruction and colorectal cancer (n = 60). Age, gender, indication, preoperative investigations, surgical procedure, complications and procedure-related mortality were registered. Patients were followed in accordance with local guidelines.
The complication rate was similar in the two groups, although there was a trend toward a higher number of severe complications in the surgical group. The hospital stay was significantly lower in the stent group, median of 4 vs. 9 days (p < 0.0001). The procedure-related mortality was lower in the stent group; 7% vs. 20% (p < 0.05).
Stenting can be safely performed with lower or similar complication rate and lower mortality rate compared to surgery and results in significantly shorter hospital stay. The results support stenting as the treatment of choice in patients with acute colonic obstruction, especially in disseminated disease.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Cheynel N, Cortet M, Lepage C, Benoit L, Faivre J, Bouvier AM (2007) Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 50(10):1568–1575
Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240(1):76–81
Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79(7):706–709
Ascanelli S, Navarra G, Tonini G, Feo C, Zerbinati A, Pozza E et al (2003) Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori 89(1):36–41
Alvarez JA, Baldonedo RF, Bear IG, Truan N, Pire G, Alvarez P (2005) Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 190(3):376–382
Sjo O, Larsen S, Lunde O, Nesbakken A (2008) Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 11(7):733–739
Ohman U (1982) Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 143(6):742–747
Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK et al (2004) Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 187(4):497–500
Dohmoto M, Hunerbein M, Schlag PM (1997) Application of rectal stents for palliation of obstructing rectosigmoid cancer. Surg Endosc 11(7):758–761
Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89(9):1096–1102
Bhardwaj R, Parker MC (2003) Palliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis 5(5):518–521
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):1455–1461
Faragher IG, Chaitowitz IM, Stupart DA (2008) Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis 10(7):668–672
Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 Suppl):S44–S49
Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21(2):225–233
Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK (2009) Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 33(6):1281–1286
Catena F, Ansaloni L, Avanzolini A, Di Saverio S, D'Alessandro L, Maldini Casadei M et al (2009) Systemic cytokine response after emergency and elective surgery for colorectal carcinoma. Int J Colorectal Dis 24(7):803–808
Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G (2010) Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 24(11):2860–2870
Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 47(4):444–450
Dronamraju SS, Ramamurthy S, Kelly SB, Hayat M (2009) Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum 52(9):1657–1661
Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246(1):24–30
Meisner S, Gonzalez-Huix F, Vandervoort JG, Goldberg P, Casellas JA, Roncero O et al (2011) Self-expandable metal stents for relieving malignant colorectal obstruction: short-term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc 74(4):876–884
van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Holzik MF, Grubben MJ et al (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12(4):344–352
van Hooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM et al (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40(3):184–191
Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I (2000) Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 216(2):492–497
Harris GJ, Senagore AJ, Lavery IC, Fazio VW (2001) The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg 181(6):499–506
Spinelli P, Mancini A (2001) Use of self-expanding metal stents for palliation of rectosigmoid cancer. Gastrointest Endosc 53(2):203–206
Sanchez W, Baron TH (2002) Palliative colonic stent placement. Gastrointest Endosc 56(5):735
Gukovsky-Reicher S, Lin RM, Sial S, Garrett B, Wu D, Lee T et al (2003) Self-expandable metal stents in palliation of malignant gastrointestinal obstruction: review of the current literature data and 5-year experience at Harbor-UCLA Medical Center. MedGenMed 5(1):16
Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90(11):1429–1433
Law WL, Choi HK, Lee YM, Chu KW (2004) Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes. Dis Colon Rectum 47(1):39–43
Dionigi G, Villa F, Rovera F, Boni L, Carrafiello G, Annoni M et al (2007) Colonic stenting for malignant disease: review of literature. Surg Oncol 16(Suppl 1):S153–S155
Vemulapalli R, Lara LF, Sreenarasimhaiah J, Harford WV, Siddiqui AA (2010) A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. Dig Dis Sci 55(6):1732–1737
Suh JP, Kim SW, Cho YK, Park JM, Lee IS, Choi MG et al (2010) Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc 24(2):400–406
Biondo S, Marti-Rague J, Kreisler E, Pares D, Martin A, Navarro M et al (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189(4):377–383
Biondo S, Kreisler E, Millan M, Fraccalvieri D, Golda T, Frago R et al (2010) Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 145(1):79–86
Anwar S, Fraser S, Hill J (2010) Surgical specialization and training—its relation to clinical outcome for colorectal cancer surgery. J Eval Clin Pract. doi:10.1111/j.1365-2753.2010.01525.x
Poon JT, Chan B, Law WL (2005) Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 48(3):493–498
Fernandez-Esparrach G, Bordas JM, Giraldez MD, Gines A, Pellise M, Sendino O et al (2010) Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 105(5):1087–1093
All authors have no conflicts of interest or financial ties to disclose.
About this article
Cite this article
Angenete, E., Asplund, D., Bergström, M. et al. Stenting for colorectal cancer obstruction compared to surgery—a study of consecutive patients in a single institution. Int J Colorectal Dis 27, 665–670 (2012). https://doi.org/10.1007/s00384-011-1374-6