Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. JH Anderson D Hole CS Mc Ardle (1992) ArticleTitleElective versus emergency surgery for patients with colorectal cancer. Br J Surg 79 706–709 Occurrence Handle1:STN:280:By2A2MzotFA%3D Occurrence Handle1379508

    CAS  PubMed  Google Scholar 

  2. NO Aston WJ Owen JD Irving (1989) ArticleTitleEndoscopic balloon dilatation of colonic anastomotic strictures. Br J Surg 76 780–782 Occurrence Handle1:STN:280:BiaA2Mzjs1E%3D Occurrence Handle2765826

    CAS  PubMed  Google Scholar 

  3. TH Baron PA Dean MR Yates et al. (1998) ArticleTitleExpandable metal stents for the treatment of colonic obstruction: technical outcomes. Gastrointest Endosc 47 277–285 Occurrence Handle1:STN:280:DyaK1c7pvF2msw%3D%3D Occurrence Handle9540883

    CAS  PubMed  Google Scholar 

  4. RM Bashir DE Fleischer TJ Stahl et al. (1996) ArticleTitleSelf-expandable nitinol coil stent for management of colonic obstruction due to a malignant anastomotic stricture. Gastrointest Endosc 44 497–501 Occurrence Handle1:STN:280:ByiD287jsFU%3D Occurrence Handle8905381

    CAS  PubMed  Google Scholar 

  5. G Bengtsson G Carlsson L Hafstrom et al. (1981) ArticleTitleNatural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141 586–589 Occurrence Handle1:STN:280:Bi6C1c7ls1I%3D Occurrence Handle7223955

    CAS  PubMed  Google Scholar 

  6. C Binelli D Chautard C Georgeac et al. (1995) ArticleTitleStenose du rectum secondaire a un envahissement d’un adenocarcinome de prostate: a propos de trois observations. J Chir 132 137–141 Occurrence Handle1:STN:280:ByqA3c7mt1c%3D

    CAS  Google Scholar 

  7. CA Binkert H Ledermann R Jost et al. (1998) ArticleTitleAcute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents. A preliminary report. Radiology 206 199–204 Occurrence Handle1:STN:280:DyaK1c%2FosFOgsw%3D%3D Occurrence Handle9423673

    CAS  PubMed  Google Scholar 

  8. F Camúňez A Echenagusia G Simó et al. (2000) ArticleTitleMalignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 216 492–497 Occurrence Handle1:STN:280:DC%2BD3cvgslWjtw%3D%3D Occurrence Handle10924576

    CAS  PubMed  Google Scholar 

  9. CL Canon TH Baron DE Morgan et al. (1997) ArticleTitleTreatment of colonic obstruction with expandable metal stents: radiological features. AJR 168 199–205 Occurrence Handle1:STN:280:ByiC3s7ivFA%3D Occurrence Handle8976946

    CAS  PubMed  Google Scholar 

  10. R Davidson WB Sweeney (1998) ArticleTitleEndoluminal stenting for benign colonic obstruction. Surg Endosc 12 353–354 Occurrence Handle10.1007/s004649900670 Occurrence Handle1:STN:280:DyaK1c3hvFChug%3D%3D Occurrence Handle9543529

    Article  CAS  PubMed  Google Scholar 

  11. LP Diaz IP Pabon RF Lobato et al. (1999) ArticleTitlePalliative treatment of malignant colorectal strictures with metallic stents. Cardiovasc Intervent Radiol 22 29–36 Occurrence Handle9929542

    PubMed  Google Scholar 

  12. P Gandrup L Lund I Balslev (1992) ArticleTitleSurgical treatment of acute malignant large bowel obstruction. Eur J Surg 158 427–430 Occurrence Handle1:STN:280:ByyD3czmvFY%3D Occurrence Handle1382624

    CAS  PubMed  Google Scholar 

  13. I Golighrer CD Hafner (1957) ArticleTitleThe treatment of acute obstruction or perforation with carcinoma of the colon and rectum. Br J Surg 450 270–274

    Google Scholar 

  14. HJ Hoekstra RCJ Varschueren J Oldhoff et al. (1985) ArticleTitlePalliative and curative electrocoagulation for rectal cancer: Experience and results. Cancer 55 210–213 Occurrence Handle1:STN:280:BiqD2szpslU%3D Occurrence Handle2578081

    CAS  PubMed  Google Scholar 

  15. M Keymling (2003) ArticleTitleColorectal stenting. Endoscopy 35 234–238 Occurrence Handle10.1055/s-2003-37265 Occurrence Handle1:STN:280:DC%2BD3s%2Fntlemsg%3D%3D Occurrence Handle12584644

    Article  CAS  PubMed  Google Scholar 

  16. E Knöpfle E Mayer G Wamser et al. (2001) ArticleTitleIlleus beim colorectalen Carcinom. Präoperative Implantation eines Metallgitterstents und frühelective Operation als Alternative zur notfallmässigen Operation. Chirurg 72 1137–1143 Occurrence Handle10.1007/s001040170051 Occurrence Handle11715616

    Article  PubMed  Google Scholar 

  17. SH Landis T Murray S Bolden et al. (1998) ArticleTitleCancer statistics 1998. CA Cancer J Clin 48 6–29 Occurrence Handle1:STN:280:DyaK1c7htFGrtg%3D%3D Occurrence Handle9449931

    CAS  PubMed  Google Scholar 

  18. WL Law KW Chu JW Ho et al. (2000) ArticleTitleSelf-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum 43 1522–1527 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt1Gjug%3D%3D Occurrence Handle11089586

    CAS  PubMed  Google Scholar 

  19. H Liberman DR Adams GJ Blatchford et al. (2000) ArticleTitleClinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg 180 407–412 Occurrence Handle1:STN:280:DC%2BD3M7lvVWrtQ%3D%3D Occurrence Handle11182388

    CAS  PubMed  Google Scholar 

  20. SK Lo (1999) ArticleTitleMetallic stenting for colorectal obstruction. Gastrointest Endosc Clin N Am 9 459–477 Occurrence Handle10388861

    PubMed  Google Scholar 

  21. I Lofler CD Hafner (1964) ArticleTitleSurvival rate in obstructing carcinoma of the colon. Arch Surg 89 716–718 Occurrence Handle14186809

    PubMed  Google Scholar 

  22. CM Lopez JMR Martinez ET Cebrian et al. (2001) ArticleTitleTreatment of left colon neoplastic obstruction by placement of self-expandable stents. Rev Esp Enferm Dig 93 232–237

    Google Scholar 

  23. A Mainar MA De Gregorio Ariza E Tejero et al. (1999) ArticleTitleAcute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery—results of a multicenter study. Radiology 210 65–69 Occurrence Handle1:STN:280:DyaK1M7gt12ktg%3D%3D Occurrence Handle9885588

    CAS  PubMed  Google Scholar 

  24. MA Mauro RE Koehler TH Baron (2000) ArticleTitleAdvances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 215 659–669 Occurrence Handle1:STN:280:DC%2BD3c3ptlChug%3D%3D Occurrence Handle10831681

    CAS  PubMed  Google Scholar 

  25. R McIntyre D Reinbach RJ Cuschieri (1997) ArticleTitleEmergency abdominal surgery in the elderly. J R Coll Surg Edinb 42 173–178 Occurrence Handle1:STN:280:ByiA3sbisFE%3D Occurrence Handle9195810

    CAS  PubMed  Google Scholar 

  26. AG Nagy (1990) ArticleTitlePalliative treatment of advanced colorectal carcinoma with the YAG laser. Can J Surg 33 261–264 Occurrence Handle1:STN:280:By%2BA2crjtlE%3D Occurrence Handle1696520

    CAS  PubMed  Google Scholar 

  27. MC Oz KA Forde (1990) ArticleTitleEndoscopic alternatives in the management of colonic strictures. Surgery 108 513–519 Occurrence Handle1:STN:280:By%2BA2s7ksV0%3D Occurrence Handle2396196

    CAS  PubMed  Google Scholar 

  28. T Patrice MT Foultier S Yactayo et al. (1990) ArticleTitleEndoscopic photodynamic therapy with hematoporphyrin derivate for primary treatment of gastrointestinal neoplasms in inoperable patients. Dig Dis Sci 35 545–552 Occurrence Handle1:STN:280:By%2BB3srntV0%3D Occurrence Handle2331950

    CAS  PubMed  Google Scholar 

  29. JJ Regland AM Londe JS Spratt (1971) ArticleTitleCorrelation on the prognosis of obstructing colorectal carcinoma with clinical and pathologic variables. Am J Surg 121 552–556 Occurrence Handle5571234

    PubMed  Google Scholar 

  30. A Repici D Reggio C De Angelis et al. (2000) ArticleTitleCovered metal stents for management of inoperable malignant colorectal strictures. Gastrointest Endosc 52 735–740 Occurrence Handle10.1067/mge.2000.109803 Occurrence Handle1:STN:280:DC%2BD3M%2FovVKhsg%3D%3D Occurrence Handle11115905

    Article  CAS  PubMed  Google Scholar 

  31. Y Saida Y Sumiyama J Nagao et al. (1996) ArticleTitleStent endoprosthesis for obstructing colorectal cancers. Dis Colon Rectum 39 552–555 Occurrence Handle1:STN:280:BymB3czmvVE%3D Occurrence Handle8620807

    CAS  PubMed  Google Scholar 

  32. JW Serpell FT McDermot H Katrivessis et al. (1989) ArticleTitleCarcinomas de colon que provocan oclusion intestinal. Br J Surg (Spanish ed) 2 549–554

    Google Scholar 

  33. K Seymour R Johnson R Marsh et al. (2002) ArticleTitlePalliative stenting of malignant large bowel obstruction. Colored Dis 4 240–245 Occurrence Handle10.1046/j.1463-1318.2002.00350.x

    Article  Google Scholar 

  34. J Tack AM Gevers P Rutgeerts (1998) ArticleTitleSelf-expandable metallic stents in the palliation of rectosigmoid carcinoma: a follow-up study. Gastrointest Endosc 48 267–271

    Google Scholar 

  35. F Turegano-Fuentes A Echenagusia-Belda G Simo-Muerza et al. (1998) ArticleTitleTransanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon. Br J Surg 85 232–235 Occurrence Handle10.1046/j.1365-2168.1998.00565.x Occurrence Handle1:STN:280:DyaK1c7mt1Cntw%3D%3D Occurrence Handle9580077

    Article  CAS  PubMed  Google Scholar 

  36. D Xinopoulos D Dimitroulopoulos K Tsamakidis et al. (2002) ArticleTitleTreatment of malignant colonic obstructions with metal stents and laser. Hepatogastroenterology 49 359–362 Occurrence Handle1:STN:280:DC%2BD383lslSjsg%3D%3D Occurrence Handle11995450

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Unit, Saint Savvas Cancer Hospital, Parnassou 35, 152 34, Athens, Greece

    D. Xinopoulos, D Dimitroulopoulos, K. Tsamakidis & E. Paraskevas

  2. First Surgical Department, Saint Savvas Cancer Hospital, Parnassou 35, 152 34, Athens, Greece

    T. Theodosopoulos, G. Bitsakou, G. Plataniotis, M. Gontikakis & P. Vassilobpoulos

  3. Economics and Statistics Department, Saint Savvas Cancer Hospital, Parnassou 35, 152 34, Athens, Greece

    M. Kontis

  4. Cass Business School, Faculty of Finance, City University, London, United Kingdom

    I. Paraskevas

Authors
  1. D. Xinopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Dimitroulopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Theodosopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Tsamakidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Bitsakou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Plataniotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Gontikakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Kontis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. Paraskevas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Vassilobpoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E. Paraskevas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D Dimitroulopoulos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 18, 421–426 (2004). https://doi.org/10.1007/s00464-003-8109-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8109-x

Keywords

Search

Navigation