Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration.
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.
Karoui
Mehdi
M
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
Charachon
Antoine
A
Delbaldo
Catherine
C
Loriau
Jérome
J
Laurent
Alexis
A
Sobhani
Iradj
I
Tran Van Nhieu
Jeanne
J
Delchier
Jean Charles
JC
Fagniez
Pierre-Louis
PL
Piedbois
Pascal
P
Cherqui
Daniel
D
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
D000970:Antineoplastic Agents