title: Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial.
abstract: BACKGROUND
  Survival in patients with stage IV unresectable rectosigmoid cancer is significantly reduced, and when patients are seen with symptoms of obstruction, it is advisable to perform a diverting colostomy before acute obstruction occurs. The aim of this study was to compare the results of endoscopic stent placement with diverting proximal colostomy in patients with stage IV rectosigmoid cancer and symptoms of chronic subacute obstruction.
  
  
  METHODS
  In a prospective randomized trial, 22 patients with stage IV unresectable rectosigmoid cancer and symptoms of chronic subacute obstruction were randomized to either endoscopic placement of an expandable stent or diverting proximal colostomy. Patients were followed until death.
  
  
  RESULTS
  There was no case of mortality or major postoperative complications. Oral feeding and bowel function were restored within 24 hours after endoscopic stent placement and within 72 hours after diverting colostomy. Hospital stays were shorter (mean, 2.6 days) in patients with endoscopic stent placement than in those with diverting stomas (mean, 8.1 days) (P < .05). Mean long-term survival was 297 days (range, 125-612 days) in patients who had stents and 280 days (range, 135-591 days) in patients with stomas (P = NS). No case of mortality during follow-up was related to the procedures. All patients with stomas found them quite unacceptable. The same feelings were present in family members. None of the patients with stents or their family members found any inconvenience about the procedure.
  
  
  CONCLUSIONS
  Endoscopic expandable stent placement offers a valid solution in patients with stage IV unresectable cancer and symptoms of chronic subacute obstruction, with shorter hospital stays. The procedure is much better accepted, psychologically and practically, by patients and their family members.
authors.affiliation: I Clinica Chirurgica Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiori
authors.forename: Antonietta
authors.initials: A
authors.lastname: Lamazza
authors.forename: Alberto
authors.initials: A
authors.lastname: Schillaci
authors.forename: Silvia
authors.initials: S
authors.lastname: Femia
authors.forename: Ercole
authors.initials: E
authors.lastname: Demasi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Decesare
authors.forename: Antonio V
authors.initials: AV
authors.lastname: Sterpetti
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D003125:Colostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000556:secondary; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012812:Sigmoidoscopy / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome