The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer

• Published in: The American journal of surgery Vol. 203; no. 6; pp. 715 - 719
• Main Authors: Lee, Won-Suk, M.D., Ph.D, Baek, Jeong-Heum, M.D., Ph.D, Kang, Jin Mo, M.D, Choi, Sangtae, M.D, Kwon, Kwang An, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cancer therapies; Chemotherapy; Chemotherapy, Adjuvant; Clinical trials; Colon; Colon - surgery; Colon neoplasm; Colonic Neoplasms - complications; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colonic Neoplasms - therapy; Colonoscopy; Colorectal cancer; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hospitals; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - mortality; Intestinal Obstruction - therapy; Kaplan-Meier Estimate; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Neoplasm Metastasis; Neoplasm Staging; Ostomy; Palliative Care - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Stent; Stents; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Survival; Survival Rate; Tomography; Treatment Outcome; Tumors; Colon neoplasm; Stent; Survival; Human; Endoprosthesis; Prognosis; Digestive system; Gut; Instrumentation therapy; Patient; Malignant tumor; Obstruction; Colonic disease; Medicine; Colon cancer; Surgery; Primary; Digestive diseases; Intestinal disease; Evolution; Advanced stage; Colon; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.05.015

Abstract Background It is still a matter of debate as to whether palliative resection of obstructive primary tumors may prolong the survival of patients with obstructive colon cancer and unresectable synchronous metastases. The main goal of this retrospective study was to compare the use of self-expanding metallic stents (SEMS) with open surgery for the palliation of patients with respect to survival, morbidity, and the time to start chemotherapy. Methods Between January 2000 and January 2008, 88 consecutive patients (52 who underwent surgery and 36 who underwent SEMS insertion) with obstructive colon cancer and unresectable synchronous metastases were retrospectively evaluated. Results The median hospital stay for all admissions was 7.2 days (range, 3–29 days) in the SEMS group and 12.3 days (range, 6–45 days) in the surgery group ( P = .001). The incidence of stoma formation was significantly lower in the SEMS group than in the surgery group (16.7% vs 38.5%, respectively, P = .021). The median time to starting chemotherapy was significantly shorter in patients who underwent SEMS insertion compared with those who underwent surgery (8.1 vs 21.7 days, respectively, P = .001). The 1-year and 2-year survival rates were 44.2% and 21.27% in the surgery group and 16.7% and 2.8% in the SEMS group, respectively. The median survival for all patients was 15 months from the initiation of treatment (95% confidence interval, 6.0–19 months). Conclusions Both procedures can be safely performed, but the choice of treatment should be individualized and discussed with a multidisciplinary team.