title: The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer.
abstract: BACKGROUND
  It is still a matter of debate as to whether palliative resection of obstructive primary tumors may prolong the survival of patients with obstructive colon cancer and unresectable synchronous metastases. The main goal of this retrospective study was to compare the use of self-expanding metallic stents (SEMS) with open surgery for the palliation of patients with respect to survival, morbidity, and the time to start chemotherapy.
  
  
  METHODS
  Between January 2000 and January 2008, 88 consecutive patients (52 who underwent surgery and 36 who underwent SEMS insertion) with obstructive colon cancer and unresectable synchronous metastases were retrospectively evaluated.
  
  
  RESULTS
  The median hospital stay for all admissions was 7.2 days (range, 3-29 days) in the SEMS group and 12.3 days (range, 6-45 days) in the surgery group (P = .001). The incidence of stoma formation was significantly lower in the SEMS group than in the surgery group (16.7% vs 38.5%, respectively, P = .021). The median time to starting chemotherapy was significantly shorter in patients who underwent SEMS insertion compared with those who underwent surgery (8.1 vs 21.7 days, respectively, P = .001). The 1-year and 2-year survival rates were 44.2% and 21.27% in the surgery group and 16.7% and 2.8% in the SEMS group, respectively. The median survival for all patients was 15 months from the initiation of treatment (95% confidence interval, 6.0-19 months).
  
  
  CONCLUSIONS
  Both procedures can be safely performed, but the choice of treatment should be individualized and discussed with a multidisciplinary team.
authors.affiliation: Department of Surgery, Gil Medical Center, Gachon University, School of Medicine, Incheon, Korea.
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Lee
authors.forename: Jeong-Heum
authors.initials: JH
authors.lastname: Baek
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Kang
authors.forename: Sangtae
authors.initials: S
authors.lastname: Choi
authors.forename: Kwang An
authors.initials: KA
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents