Incurable Stenosing Colorectal Carcinoma: Endoscopic Stent Implantation or Palliative Surgery?

Abstract

Palliative treatment of incurable obstructive colorectal carcinoma using stents is an effective and suitable alternative to palliative surgery with no negative impact on the survival but less peri-interventional morbidity and mortality as well as comparable overall morbidity.

Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

“…There have been many reports on the comparisons of OS between SEMS insertion and palliative surgery [3,4,8,9,10,15,21,27,28,29]. The data from these reports show no statistical difference in survival outcomes between these two methods as first intervention.…”

“…The deaths following SEMS placement were unrelated to the procedure, and all patients died of advanced malignancy. Although one study reported no differences in mortality and morbidity rates between the two groups [8], most other reports, including our study, showed that the SEMS group had a lower mortality rate than the surgery group [4,8,9,10,15,23,27,28,29]. …”

Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction

“…However, emergency surgical decompression of the bowel is associated with high morbidity and mortality rates. In addition, curative resection is not feasible for up to 30% of patients with obstruction because of extensive tumor infiltration, distant metastasis, or significant comorbidity [2][3][4][5].Self-expanding metal stents (SEMS) have been used for the management of colorectal obstruction as an alternative to emergency surgery [6]. Placement of SEMS is a safe and effective definitive procedure for the palliation of malignant colorectal obstruction.…”

“…However, emergency surgical decompression of the bowel is associated with high morbidity and mortality rates. In addition, curative resection is not feasible for up to 30% of patients with obstruction because of extensive tumor infiltration, distant metastasis, or significant comorbidity [2][3][4][5].…”

Stenting for malignant colorectal obstruction: a single-center experience with 101 patients

“…Compared with emergency surgery, SEMS placement and subsequent elective surgery lead to higher rates of primary anastomosis and lower rates of colostomies [7,8]. In palliative stenting, morbidity and mortality are lower, hospitalization is shorter, and long-term survival is similar to that with traditional palliative surgery [9][10][11].Advanced extracolonic malignancies such as metastatic gynecologic, pancreatic, and gastric cancer can also cause colorectal obstruction. In these cases, the bowel obstruction develops from tumor invasion into the lumen or from extrinsic compression.…”