Quality of Life and Symptom Control after Stent Placement or Surgical Palliation of Malignant Colorectal Obstruction

Nagula, Satish; Ishill, Nicole; Nash, Carla; Markowitz, Arnold J.; Schattner, Mark; Temple, Larissa K.; Weiser, Martin R.; Thaler, Howard T.; Zauber, Ann G.; Gerdes, Hans

doi:10.1016/j.jamcollsurg.2009.09.039

Cited by 80 publications

(66 citation statements)

References 26 publications

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“…In this small study, two of the ten patients undergoing surgery and stoma formation had subsequent complications from their stoma, and one required a revision. Quality of life is recognized as the most important factor in palliative surgery25, and the impact of stomas on quality of life has been well described9 10. In the present study, 17 (81 per cent) of the 21 patients undergoing colonic restenting could be palliated successfully, without a stoma, until their death, supporting the role of repeat stenting in the context of palliative care.…”

Section: Discussionsupporting

confidence: 61%

“…Earlier studies2 3 on stenting suggested a high rate of perforation, although more recent series4, 5, 6, 7 have demonstrated an acceptably low level of complications and high clinical success rates. Compared with palliative surgery, stenting has a lower clinical success rate but a shorter stay in hospital, a reduction in complications, reduced stoma formation, earlier commencement of chemotherapy and improved quality of life8, 9, 10, 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

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Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

et al. 2017

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BackgroundEndoscopic stenting is used to palliate malignant large bowel obstruction. A proportion of patients will develop recurrent obstruction due to tumour ingrowth and require reintervention. This study aimed to assess the outcome (clinical success and complication rates) of endoscopic reintervention compared with surgical intervention in patients with stent obstruction due to tumour ingrowth.MethodsThis was an observational study using data from a database of patients who underwent palliative colonic stenting between January 1998 and March 2017 at Christchurch Public Hospital.ResultsA total of 190 patients underwent colonic stent insertion, for palliation in 182 cases. Reintervention was performed in 55 (30·2 per cent). Thirty‐one patients (17·0 per cent) developed obstruction within the stent at a median of 4·6 (i.q.r. 2·3–7·7) months after the procedure. Of these, 21 had endoscopic restenting and ten underwent surgery. Restenting had technical and clinical success rates of 100 per cent, and involved a significantly shorter length of stay compared with surgery (median 2 (i.q.r. 1–4) versus 11 (6–19) days respectively; P = 0·006). Seven of the 21 patients in the restented group underwent a third palliative intervention. The overall stoma rate in the restented group was significantly lower than that in the surgical group (4 of 21 versus 10 of 10; P < 0·001). There was no difference in complications or survival between the two groups.ConclusionAmong palliative patients who develop malignant stent obstruction, endoscopic restenting had a high chance of technical success. It resulted in a shorter hospital stay and lower stoma rate than those seen after surgery.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

et al. 2017

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“…Advantages include technical and clinical success rates exceeding 90%, 5 stentrelated mortality of less than 1% 5 and possibly improved quality of life compared with palliative surgery. 6,7 The potential complications of SEMS placement include stent migration, reobstruction and, the most worrisome, colonic perforation. The incidence of the latter approaches 4% 5 and is a serious concern for clinicians because mortality after emergency surgery for a perforated CRC has been found to be approximately 20%-30% in recent studies.…”

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confidence: 99%

Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

et al. 2015

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Background: Self-expanding metal stents (SEMS) are increasingly used in the treatment of malignant large bowel obstruction in the setting of inoperable colorectal cancer. Perforation is a well-known complication associated with these devices. The addition of the vascular endothelial growth factor inhibitor bevacizumab is suspected to increase the rate, but the extent of the increase is not known. Methods:We retrospectively reviewed the records of patients receiving SEMS in tertiary hospitals in Calgary, Alta., between October 2001 and January 2012. Results:We reviewed the records of 87 patients with inoperable colorectal cancer who received SEMS during our study period. Nine perforations occurred in total: 4 of 30 (13%) patients who received no chemotherapy, 3 of 47 (6%) who received chemotherapy but no bevacizumab, and 2 of 10 (20%) who received chemotherapy and bevacizumab. These two patients received bevacizumab with FOLFIRI after SEMS placement, and they had peritoneal disease. Conclusion:Our case series and other studies suggest that bevacizumab may increase the risk of colonic perforation in the setting of SEMS. Caution should be used when combining these therapies.

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“…In addition, three of the seven patients who eventually underwent diverting colostomy creation had a previous failed stent insertion, but none experienced a stent-related perforation [Poultsides et al 2009]. Nonetheless, stent placement has been found to improve quality of life scores in prospective studies of patients with malignant colorectal obstruction [Nagula et al 2010], and remains a useful option for the symptomatic palliation of these patients, particularly when declining performance status precludes surgical intervention.…”

Section: Palliation Of Intestinal Complications By Nonsurgical Methodsmentioning

confidence: 99%

Reassessing the need for primary tumor surgery in unresectable metastatic colorectal cancer: overview and perspective

Poultsides

Paty

2010

Ther Adv Med Oncol

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In the absence of symptoms, primary tumor resection in patients who present with unresectable metastatic colorectal cancer is of uncertain benefit. Prophylactic surgery has been traditionally considered in this setting in order to prevent subsequent complications of perforation, obstruction, or bleeding later during the treatment course, which may require urgent surgery associated with higher mortality. However, recent data have called into question the efficacy of this upfront surgical strategy. We provide a brief overview of how current combinations of systemic chemotherapy including fluorouracil, oxaliplatin, irinotecan, and targeted biologic agents have allowed improved local (in addition to distant) tumor control, significantly decreasing the incidence of late primary-related complications requiring surgery from roughly 20% in the era of single-agent fluoropyrimidine chemotherapy to almost 7% in the era of modern triple-drug chemotherapy. In addition, we attempt to highlight those factors most associated with subsequent primary tumor-related complications in an effort to identify the subset of patients with synchronous metastatic colorectal cancer who might benefit from a surgery-first approach. Finally, we discuss modern nonsurgical options available for palliation of the primary colorectal tumor and review the outcome of patients for which emergent surgery is eventually required to address primary-related symptoms.

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Quality of Life and Symptom Control after Stent Placement or Surgical Palliation of Malignant Colorectal Obstruction

Cited by 80 publications

References 26 publications

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

Reassessing the need for primary tumor surgery in unresectable metastatic colorectal cancer: overview and perspective

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