Colorectal Stenting of Obstructive Colorectal Cancer: Multicenter Study in Korea

Abstract

Background: Malignant obstruction of the colon occurs in 8-25% of patients with colorectal cancer. Emergent surgical intervention can cause high morbidity and mortality. Aim: 1) To evaluate the clinical usefulness of preoperative stenting in resectable obstructive colorectal cancer. 2) To evaluate the clinical usefulness of palliative stenting in unresectabe obstructive colorectal cancer. 3) To compare the cost-effectiveness between stenting group and surgery group in curative or palliative purpose with multicenter study in Korea. Methods: Retrospective review of 201 patients with clinical or radiological evidence of malignant colon obstruction in three university hospital between Jan 1999 and Jan 2004. 55 patients underwent curative operation after stenting, 59 patients performed curative operation without stenting. 58 patients performed palliative stent for advanced disease. 29 patients underwent palliative operation without stent. We compared emergency operation group with preoperative stenting and surgery group, and also palliative stenting group with palliative surgery group. Results: In curative aim group, sites of obstruction were rectum (n = 30), rectosigmoid (n = 8), sigmoid (n = 57), descending colon (n = 9), splenic flexure (n = 7), distal transverse colon(n = 3). Operation after stenting group underwent one-stage operation (87.3%, p < 0.05). The incidence of complication was significant higher in one-stage operation group than pre-operative stenting group (p < 0.05). The mean postoperative hospital stays are 25 ± 10.4 days in preoperative stenting group and 33.7 ± 18 days in emergency operation group (p < 0.05). In palliative treated group, obstructive sites were rectum (n = 21), rectosigmoid (n = 10), sigmoid (n = 38), descending colon (n = 6), splenic flexure (n = 7), distal transverse colon (n = 5). Permanent stoma was remained in 15.5% of palliative stenting group and in 69% of palliative operation group (p < 0.05). The median hospital stays for palliative stent and palliative operation group were 10.5 ± 11.4 days vs. 22.7 ± 18.5 days, respectively (p < 0.05). Cost effectiveness between two groups was not significantly. Conclusions: In preoperative stenting group, the rate of one-stage operation is higher; complication rates and hospital stay duration are lower than those of emergent operation group. In palliative stenting group, the rate of permanent stoma, complication rate and duration of hospital-stay are lower than those of palliative operation group of incurable colorectal cancer.