Stent or surgery for incurable obstructive colorectal cancer: an individualized decisión

Abstract

Stent placement offers advantages regarding early morbidity, hospital stay and stoma creation. Surgery offers a benefit in survival in patients who receive chemotherapy but not in non-candidates to chemotherapy.

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.…”

“…With one exception, the authors of these reports concluded that SEMS was highly effective and safe compared to surgery with regard to cost and mortality despite the fact that SEMS did not increase the survival rate. The report in exception asserted that palliative surgery offered a benefit of survival in patients who received chemotherapy but not in those patients unable to receive chemotherapy [3]. All of these reports dealt with surgery or SEMS insertion as the initial approach for treatment of the first colorectal obstruction event.…”

“…However, whether one strategy is superior over the other for patients with unresectable, malignant colorectal obstruction remains unclear because the methods have differing merits and demerits [1,2,3,4,5]. …”

Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction

“…A recent multicenter, randomized, clinical trial comparing endoscopic stenting and surgery was stopped early because of high complication rates for SEMSs. 6 Other recent reports have shown that placement of SEMSs was ineffective as an initial approach for malignant colorectal obstruction, [7][8][9] and other negative aspects have been demonstrated. 10 Although the success rate for stenting was relatively high, these data suggest that failures are not negligible in patients with obstructive colorectal cancer.…”

Palliative self-expandable metal stents for acute malignant colorectal obstruction: clinical outcomes and risk factors for complications

“…Third, we did not compare short-and long-term outcomes between surgical decompression and SEMS placement for acute malignant obstruction. However, many studies have reported that SEMS placement is safer and more effective than emergency surgery for treating malignant obstruction in patients with primary CRC [19,[31][32][33]. Fourth, this retrospective study did not investigate the factors affecting the choice of SEMS type, although the skilled endoscopists determined the types of SEMS based on the risk of complications such as late migration or tumor ingrowth.…”