title: Palliative colonic stenting: a safe alternative to surgery in stage IV colorectal cancer.
abstract: BACKGROUND
  The morbidity associated with surgery for obstructing or near-obstructing stage IV colorectal cancer can be high including the frequent need for a stoma. Self-expandable metal stents (SEMS) offer an alternative to surgery. Our aim was to analyse our palliative SEMS outcomes and compare this with a palliative surgery group.
  
  
  METHODS
  A retrospective study of a single institutions' experience with SEMS or surgery in the management of stage IV colorectal cancer was performed.
  
  
  RESULTS
  Sixty-five patients treated with SEMS were included in the study. These were compared with an unmatched group of 63 patients who underwent surgery. Within the SEMS group was a 98.5% technical success and 100% clinical success of deployed SEMS. Overall complication rate was low at 23.1% (restenosis 7.7%, migration 7.7%, perforation 4.6% and bleeding 3.1%). Only 7.7% of patients in the SEMS group required an operation. SEMS insertion was associated with a shorter hospital stay (2.9 days versus 14.6 days; P < 0.001) and reduced requirement for a stoma (4.6% versus 44.4%; P < 0.001). There was no statistically significant difference in 30-day mortality (13.8% versus 11.1%; P = 0.640), 1-year survival (42.9% versus 41.4%; P = 0.949) or 2-year survival (24.5% versus 21.4%; P = 0.700). Overall survival was equivalent between the two groups (hazard ratio 1.27; 95% confidence interval 0.88-1.88; P = 0.212).
  
  
  CONCLUSIONS
  SEMS is a safe alternative to surgery in obstructing or near-obstructing stage IV colorectal cancer. It offers high success rate, a shorter hospital stay and a reduced stoma rate while not impacting overall survival.
authors.affiliation: General Surgery Department, North Shore Hospital, Auckland, New Zealand. andyfin@iinet.net.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Finlayson
authors.affiliation: General Surgery Department, North Shore Hospital, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Hulme-Moir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: colorectal cancer; colostomy; intestinal obstruction; palliative treatment; stent