Outcomes in the management of obstructive unresectable stage IV colorectal cancer.
OBJECTIVE
To analyze short term results and to report survival rates in a series of patients after palliative emergency treatment for obstructive left sided colorectal cancer (CRC) with unresectable synchronous metastases.


METHODS
From 2004 to 2008, 55 patients were included. Palliative management consisted of stenting to recover bowel patency and starting chemotherapy. Indications for surgery were perforation or failure of stenting. Early failure occurred when decompression after insertion was unsuccessful and late failure when obstruction occurred after successful decompression. Morbidity and mortality were analyzed for stenting and surgery and survival for resected and non-resected patients.


RESULTS
Stenting was scheduled in 49 patients.Morbidity and mortality occurred in 5 and 3 patients respectively. Early failure occurred in 4 patients and late failure in 11 patients. Surgery was indicated in 6 patients for peritonitis at diagnosis and in 11 patients for complications (1 case) or stenting failure (10 cases). Of the 17 operated patients, 12 cases were resected and 5 cases were not. Mortality occurred in 1 case. Resected patients received first-line (12 cases) and second-line (5 cases) systemic chemotherapy based on FOLFIRI or FOLFOX while stented and non-resected patients were similarly treated in 37 cases and 12 cases respectively. Overall survival at 2 years was 39.3% in resected patients and 1% in stented and non-resected patients (p = 0.008).


CONCLUSIONS
Stenting in palliative stage IV obstructive CRC patients may be less successful as previously thought. Prospective studies are needed to define the role of palliative resection.
Frago
R
R
Department of Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
Kreisler
E
E
Biondo
S
S
Salazar
R
R
Dominguez
J
J
Escalante
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D003125:Colostomy; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D002955:Leucovorin / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin