Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction.
BACKGROUND
Emergent surgical management of malignant large bowel obstruction (LBO) carries a high rate of morbidity and mortality. Self-expanding metal stents have emerged as an alternative for palliation of malignant LBO. However, there are few long-term studies documenting the effect of surgical palliation or colonic stents on symptoms or quality of life (QoL).


METHODS
Between 2003 and 2006, patients with unresectable-for-cure malignancies presenting with LBO were enrolled in this prospective study. Patients elected to undergo stent placement or surgical palliation. Patients completed a symptom questionnaire and a QoL instrument (Functional Assessment of Cancer Therapy-Colorectal [FACT-C]) at weeks 1, 2, 4, 8, 12, and 24 after palliation. Symptoms were assessed using the Colon Obstruction Score, a novel instrument comprising nausea, vomiting, pain, distension, and bowel movement frequency scores.


RESULTS
Thirty patients had successful stent placement; 14 underwent surgical diversion. Colon Obstruction Scores immediately improved after both stent placement and surgery (p < 0.05 for all time points). Composite FACT-C scores progressively improved after stent placement (p = NS), with the colon symptoms subscale improving after 1 month (p < 0.05). FACT-C scores declined initially after surgery and then returned to baseline, with modest improvements seen in the Colon Symptoms subscale (p = NS).


CONCLUSIONS
Both stent placement and surgical diversion provide durable improvement in symptoms from LBO, as readily assessed by the Colon Obstruction Score. QoL is difficult to assess in terminal cancer patients, but colon stent placement is associated with improved overall QoL and QoL related to gastrointestinal symptoms.
Nagula
Satish
S
Department of Medicine, Gastroenterology, and Nutrition Service, Memorial-Sloan Kettering Cancer Center, New York, NY 10065, USA.
Ishill
Nicole
N
Nash
Carla
C
Markowitz
Arnold J
AJ
Schattner
Mark A
MA
Temple
Larissa
L
Weiser
Martin R
MR
Thaler
Howard T
HT
Zauber
Ann
A
Gerdes
Hans
H
D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012086:Reoperation; D015607:Stents