1. A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer.
- Author
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Vemulapalli R, Lara LF, Sreenarasimhaiah J, Harford WV, and Siddiqui AA
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Colonic Diseases etiology, Colonic Diseases mortality, Colonic Diseases surgery, Colonic Neoplasms mortality, Emergency Treatment, Female, Hospital Mortality, Humans, Intestinal Obstruction etiology, Intestinal Obstruction mortality, Intestinal Obstruction surgery, Kaplan-Meier Estimate, Length of Stay, Male, Metals, Middle Aged, Prosthesis Design, Retrospective Studies, Risk Assessment, Texas epidemiology, Time Factors, Treatment Outcome, Young Adult, Colonic Diseases therapy, Colonic Neoplasms complications, Colostomy adverse effects, Colostomy mortality, Intestinal Obstruction therapy, Palliative Care methods, Stents adverse effects
- Abstract
Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer., Methods: A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed. The primary endpoint was relief of obstruction. Secondary endpoints include technical success of the procedure, duration of hospital stay, early and long-term complications, and overall survival., Results: Both groups were similar in age, sex, and tumor distribution. Placement of SEMS was successful in 50/53 (94%) patients. Surgery was effective in relieving obstruction in 70/70 (100%) patients. Patients in the SEMS group have a significantly shorter median hospital stay (2 days) as compared to the surgery group (8 days) (P < 0.001). Patients with SEMS also had significantly less acute complications compared to the surgery group (8 vs. 30%, P = 0.03). The hospital mortality for the SEMS group was 0% compared to 8.5% in patients that underwent surgical decompression (P = 0.04). There was no difference in survival between the two groups (P = 0.76)., Conclusions: In patients with colorectal cancer and obstructive symptoms, SEMS provide a highly effective and safe therapy when compared to surgery. In most patients with metastatic colorectal cancer and obstruction, SEMS provide a minimally invasive alternative to surgical intervention.
- Published
- 2010
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