A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer.
BACKGROUND
Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer.


METHODS
A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed. The primary endpoint was relief of obstruction. Secondary endpoints include technical success of the procedure, duration of hospital stay, early and long-term complications, and overall survival.


RESULTS
Both groups were similar in age, sex, and tumor distribution. Placement of SEMS was successful in 50/53 (94%) patients. Surgery was effective in relieving obstruction in 70/70 (100%) patients. Patients in the SEMS group have a significantly shorter median hospital stay (2 days) as compared to the surgery group (8 days) (P < 0.001). Patients with SEMS also had significantly less acute complications compared to the surgery group (8 vs. 30%, P = 0.03). The hospital mortality for the SEMS group was 0% compared to 8.5% in patients that underwent surgical decompression (P = 0.04). There was no difference in survival between the two groups (P = 0.76).


CONCLUSIONS
In patients with colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy when compared to surgery. In most patients with metastatic colorectal cancer and obstruction, SEMS provide a minimally invasive alternative to surgical intervention.
Vemulapalli
Roopa
R
University of Texas Southwestern Medical School, Dallas, TX, USA.
Lara
Luis F
LF
Sreenarasimhaiah
Jayaprakash
J
Harford
William V
WV
Siddiqui
Ali A
AA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003110:Colonic Neoplasms / Q000150:complications* / Q000401:mortality; D003125:Colostomy / Q000009:adverse effects / Q000401:mortality; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D008670:Metals
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