Abstract:

BACKGROUND: Little is known about the outcomes of stent therapy for relief of malignant colorectal obstruction in advanced colorectal cancer patients, especially for the long-term outcomes.
OBJECTIVE: To compare the effect of self-expanding metal stent and palliative surgery in advanced colorectal cancer patients with malignant colorectal obstruction.
METHODS: Totally 186 patients with incurable obstructive colorectal cancers who underwent self-expanding metal stent and palliative surgery were included. Information including sex, age, obstruction sites, metastatic sites, type of stent, diameter of stent, postoperative complications, length of hospital admission, chemotherapy, time to chemotherapy administration and late obstruction were retrospective analyzed. Short-term and long-term outcomes were compared between the two groups. Multivariate logistic regression analysis was used to estimate the strength of association between late obstruction and various factors.
RESULTS AND CONCLUSION: The technical success rate in the stent group was lower than that in the surgery group (P=0.030), and the rates of clinical success in the two groups had no difference. The stent group had fewer postoperative complications than the surgery group, but the rates of major complications had no difference between the two groups (P=0.839). The stent group had a shorter time in length of hospital admission and time to chemotherapy administration, but a higher rate of late obstruction as compared with the surgery group (P=0.028). Diameter of stent and chemotherapy were independent risk factors for late obstruction. These findings indicate that the self-expanding metal stent is an effective therapy with a better early outcome for malignant colorectal obstruction, but it has a worse long-term outcome than palliative surgery, especially for chemotherapy patients with a smaller diameter of stent, who may need stent reinsertion or a second surgery to relieve late obstruction.