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Palliative colonic stenting: a safe alternative to surgery in stage IV colorectal cancer
Author(s) -
Finlayson Andrew,
HulmeMoir Michael
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12821
Subject(s) - medicine , stoma (medicine) , colorectal cancer , hazard ratio , surgery , perforation , stage (stratigraphy) , confidence interval , cancer , paleontology , materials science , biology , punching , metallurgy
Background The morbidity associated with surgery for obstructing or near‐obstructing stage IV colorectal cancer can be high including the frequent need for a stoma. Self‐expandable metal stents ( SEMS ) offer an alternative to surgery. Our aim was to analyse our palliative SEMS outcomes and compare this with a palliative surgery group. Methods A retrospective study of a single institutions' experience with SEMS or surgery in the management of stage IV colorectal cancer was performed. Results Sixty‐five patients treated with SEMS were included in the study. These were compared with an unmatched group of 63 patients who underwent surgery. Within the SEMS group was a 98.5% technical success and 100% clinical success of deployed SEMS . Overall complication rate was low at 23.1% (restenosis 7.7%, migration 7.7%, perforation 4.6% and bleeding 3.1%). Only 7.7% of patients in the SEMS group required an operation. SEMS insertion was associated with a shorter hospital stay (2.9 days versus 14.6 days; P < 0.001) and reduced requirement for a stoma (4.6% versus 44.4%; P < 0.001). There was no statistically significant difference in 30‐day mortality (13.8% versus 11.1%; P = 0.640), 1‐year survival (42.9% versus 41.4%; P = 0.949) or 2‐year survival (24.5% versus 21.4%; P = 0.700). Overall survival was equivalent between the two groups (hazard ratio 1.27; 95% confidence interval 0.88–1.88; P = 0.212). Conclusion SEMS is a safe alternative to surgery in obstructing or near‐obstructing stage IV colorectal cancer. It offers high success rate, a shorter hospital stay and a reduced stoma rate while not impacting overall survival.