title: Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration.
abstract: OBJECTIVE
  The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  University tertiary care referral center.
  
  
  METHODS
  From January 1, 1996, to September 15, 2005, 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with self-expanding colonic metallic stent (SEMS) (n = 31) or surgery (n = 27).
  
  
  METHODS
  Comparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival.
  
  
  RESULTS
  Mortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5 days, respectively; P < .01). Incidence of stoma creation was lower in patients treated with SEMS than in patients treated with surgery (6% vs 37%, respectively; P = .02). The median time to chemotherapy administration was shorter after SEMS insertion than after surgery (14.0 vs 28.5 days, respectively; P = .002). Three patients with SEMS and 0 patients in the surgical group underwent a curative colonic and hepatic resection after downstaging by chemotherapy (P = .27). Two patients (6%) with SEMS and undergoing chemotherapy had a tumor perforation requiring emergency surgery. There was no difference in survival between the 2 groups (median survival, 13.7 months for SEMS vs 11.4 months for surgery; P = .19).
  
  
  CONCLUSIONS
  Insertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention.
authors.affiliation: Department of Surgery, Service de Chirurgie Digestive, Hôpital Henri Mondor, 51 av du Maréchal de Lattre-de-Tassigny, 94010 Créteil CEDEX, France. mehdi.karoui@hmn.aphp.fr
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
authors.forename: Antoine
authors.initials: A
authors.lastname: Charachon
authors.forename: Catherine
authors.initials: C
authors.lastname: Delbaldo
authors.forename: Jérome
authors.initials: J
authors.lastname: Loriau
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Iradj
authors.initials: I
authors.lastname: Sobhani
authors.forename: Jeanne
authors.initials: J
authors.lastname: Tran Van Nhieu
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Delchier
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Fagniez
authors.forename: Pascal
authors.initials: P
authors.lastname: Piedbois
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002423:Cause of Death; D003082:Colectomy; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006760:Hospitalization; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy / Q000601:surgery*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D054047:Surgical Stomas; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents