Stents for Palliation of Obstructive Metastatic Colon Cancer

Abstract

Hypothesis:The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy.Design: A retrospective study.Setting: University tertiary care referral center. , 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with selfexpanding colonic metallic stent (SEMS) (n=31) or surgery (n=27). Main Outcome Measures:Comparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival.Results: Mortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5

Recent Advances in the Management of Stage IV Colon Cancer

“…Such obstructions have traditionally been treated with surgery involving a two-stage procedure of resection and stoma formation, which has been associated with a high morbidity and mortality [87]. A onestage operation including either a subtotal colectomy + ileocolic anastomosis or a segmental resection + primary anastomosis after intraoperative colonic decompression have been reported; however, this aggressive approach is reported to be achievable in only two-thirds (66%) of patients [88]. The mortality rate of colostomy is high and may greatly diminish the quality of life, especially as up to 50% of patients will never have a colostomy reversal [89].…”

“…The balance between benefits and challenges of using this noninvasive technique does not strongly promote or discourage their use; therefore, the literature remains at odds on the clinical applications of SEMSs. No difference in survival has been reported between patients treated with stents vs surgery [88]. The long-term efficacy and safety of SEMS has yet to be fully elucidated, complicating treatment comparisons, particularly, as the survival of patients with unresectable CC has increased from 11 -13 months to 14.8 -21.5 months [94].…”

“…A study by Karoui et al found the median hospital stay to be five days shorter for patients treated with SEMSs as opposed to surgery (8.0 vs 13.5 days). In this context, a rapid recovery allowed earlier administration of chemotherapeutics (14.0 vs 28.5 days) [88]. Stents additionally offer the advantage of an improved quality of life with greater comfort as stoma formation may be avoided and is therefore more cost effective than surgery [88,92].…”

“…In this context, a rapid recovery allowed earlier administration of chemotherapeutics (14.0 vs 28.5 days) [88]. Stents additionally offer the advantage of an improved quality of life with greater comfort as stoma formation may be avoided and is therefore more cost effective than surgery [88,92]. High rates of technical (96%) and clinical success (92%) have been achieved; however, this study also reported that nearly one-third of patients (31%) required a repeat colonoscopy for symptoms of obstruction [92].…”

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

“…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.…”