title: Stenting for colorectal cancer obstruction compared to surgery--a study of consecutive patients in a single institution.
abstract: BACKGROUND
  Colonic obstruction is a common complication to colorectal cancer and surgical treatment is associated with high morbidity and mortality. Stenting has emerged as an alternative to surgery. The aim of this study was to compare short-term morbidity, mortality and hospital stay between treatment with self-expandable metallic stent and emergency surgery performed at our department during a 5-year period in a non-randomized setting.
  
  
  METHODS
  Patients with colonic obstruction due to rectal or colon cancer referred to the Endoscopic Unit or Surgical Department for insertion of a colonic stent between 1 August 2003 and 1 August 2008 were prospectively registered and followed (n = 112). A control group was identified using the hospital records of operations with the International Classification Code-10 (ICD-10) for bowel obstruction and colorectal cancer (n = 60). Age, gender, indication, preoperative investigations, surgical procedure, complications and procedure-related mortality were registered. Patients were followed in accordance with local guidelines.
  
  
  RESULTS
  The complication rate was similar in the two groups, although there was a trend toward a higher number of severe complications in the surgical group. The hospital stay was significantly lower in the stent group, median of 4 vs. 9 days (p < 0.0001). The procedure-related mortality was lower in the stent group; 7% vs. 20% (p < 0.05).
  
  
  CONCLUSIONS
  Stenting can be safely performed with lower or similar complication rate and lower mortality rate compared to surgery and results in significantly shorter hospital stay. The results support stenting as the treatment of choice in patients with acute colonic obstruction, especially in disseminated disease.
authors: Department of Surgery, Sahlgrenska University Hospital/Östra Sjukhuset, 416 85 Gothenburg, Sweden. eva.angenete@vgregion.se
authors: Eva
authors: E
authors: Angenete
authors: Dan
authors: D
authors: Asplund
authors: Maria
authors: M
authors: Bergström
authors: Per-Ola
authors: PO
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004638:Emergency Treatment; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology / Q000601:surgery; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome