A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer. Methods: A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed. The primary endpoint was relief of obstruction. Secondary endpoints include technical success of the procedure, duration of hospital stay, early and long-term complications, and overall survival. Results: Both groups were similar in age, sex, and tumor distribution. Placement of SEMS was successful in 50/53 (94%) patients. Surgery was effective in relieving obstruction in 70/70 (100%) patients. Patients in the SEMS group have a significantly shorter median hospital stay (2 days) as compared to the surgery group (8 days) (P < 0.001). Patients with SEMS also had significantly less acute complications compared to the surgery group (8 vs. 30%, P = 0.03). The hospital mortality for the SEMS group was 0% compared to 8.5% in patients that underwent surgical decompression (P = 0.04). There was no difference in survival between the two groups (P = 0.76). Conclusions: In patients with colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy when compared to surgery. In most patients with metastatic colorectal cancer and obstruction, SEMS provide a minimally invasive alternative to surgical intervention.

Original languageEnglish (US)
Pages (from-to)1732-1737
Number of pages6
JournalDigestive Diseases and Sciences
Volume55
Issue number6
DOIs
StatePublished - Jun 2010

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Colonic Neoplasms
Stents
Metals
Colorectal Neoplasms
Length of Stay
Surgical Decompression
Sex Distribution
Survival
Hospital Mortality
Neoplasms
Emergencies
Therapeutics

Keywords

  • Acute colonic obstruction
  • Colorectal cancer
  • Colostomy
  • Self-expanding metal stents

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. / Vemulapalli, Roopa; Lara, Luis F.; Sreenarasimhaiah, Jayaprakash; Harford, William V.; Siddiqui, Ali A.

In: Digestive Diseases and Sciences, Vol. 55, No. 6, 06.2010, p. 1732-1737.

Research output: Contribution to journalArticle

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abstract = "Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer. Methods: A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed. The primary endpoint was relief of obstruction. Secondary endpoints include technical success of the procedure, duration of hospital stay, early and long-term complications, and overall survival. Results: Both groups were similar in age, sex, and tumor distribution. Placement of SEMS was successful in 50/53 (94{\%}) patients. Surgery was effective in relieving obstruction in 70/70 (100{\%}) patients. Patients in the SEMS group have a significantly shorter median hospital stay (2 days) as compared to the surgery group (8 days) (P < 0.001). Patients with SEMS also had significantly less acute complications compared to the surgery group (8 vs. 30{\%}, P = 0.03). The hospital mortality for the SEMS group was 0{\%} compared to 8.5{\%} in patients that underwent surgical decompression (P = 0.04). There was no difference in survival between the two groups (P = 0.76). Conclusions: In patients with colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy when compared to surgery. In most patients with metastatic colorectal cancer and obstruction, SEMS provide a minimally invasive alternative to surgical intervention.",
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