Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery.
BACKGROUND
Self-expandable metal stents (SEMSs) provide a promising alternative for initial palliation of malignant bowel obstruction. However, data on the long-term outcomes of SEMSs are limited.


OBJECTIVE
The aim of this study was to compare the long-term outcomes of endoscopic stenting with those of surgery for palliation in patients with incurable obstructive colorectal cancer. DESIGNS AND SETTING: A retrospective study.


METHODS
From January 2000 to December 2008, patients with incurable obstructive colorectal cancer who were treated with SEMSs (n = 71) or palliative surgery (n = 73) were reviewed.


METHODS
SEMS placement by using through-the-endoscope methods or surgery.


METHODS
Success rates and complication rates.


RESULTS
Early success rates in the SEMS group and those in the surgery group were not different (95.8% vs 100%, P = .12), and the SEMS group had fewer early complications than the surgery group (15.5% vs 32.9%, P = .015). Although the patency duration of the first stent in the SEMS group was shorter than that in the surgery group (P < .001), the median patency duration after a second stenting was comparable to that of the surgery group (P = .239). There were more late complications in the SEMS group than in the surgery group (P = .028), but the rates of major complications did not differ between the 2 groups (P = .074).


CONCLUSIONS
Retrospective and single-center study.


CONCLUSIONS
SEMSs were not only an effective and acceptable therapy for initial palliation of malignant colorectal obstruction, but they also showed long-term efficacy comparable to that with surgery.
Division of Gastroenterology, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
Hyun Jung
HJ
Lee
Sung Pil
SP
Hong
Jae Hee
JH
Cheon
Tae Il
TI
Kim
Byung So
BS
Min
Nam Kyu
NK
Kim
Won Ho
WH
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome