Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis

Xinopoulos, Dimitrios; Dimitroulopoulos, Dimitrios; Theodosopoulos, T.; Tsamakidis, Klisthenis; Bitsakou, Georgia; Plataniotis, G.; Gontikakis, Emmanuel; Kontis, Marios; Paraskevas, Ioannis; Vassilobpoulos, P.; Paraskevas, E.

doi:10.1007/s00464-003-8109-x

Cited by 184 publications

(48 citation statements)

References 28 publications

(35 reference statements)

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“…These findings are consistent with those of previous reports despite the fact that these data are results of a second SEMS insertion. Previously reported median duration of the first stent patency ranged from 83 to 204 days [5,6,7,8,9]. We observed a median duration of stent-in-stent patency of 170 days in patients who achieved immediate clinical success, which is comparable to those of first-line colorectal SEMS [17].…”

Section: Discussionsupporting

confidence: 70%

“…There have been many reports on the comparisons of OS between SEMS insertion and palliative surgery [3,4,8,9,10,15,21,27,28,29]. The data from these reports show no statistical difference in survival outcomes between these two methods as first intervention.…”

Section: Discussionmentioning

confidence: 57%

“…The deaths following SEMS placement were unrelated to the procedure, and all patients died of advanced malignancy. Although one study reported no differences in mortality and morbidity rates between the two groups [8], most other reports, including our study, showed that the SEMS group had a lower mortality rate than the surgery group [4,8,9,10,15,23,27,28,29]. …”

Section: Discussionmentioning

confidence: 61%

“…Palliative surgery is associated with a high mortality rate ranging between 10 and 34% [6,7,8], high cost [9], an increase in the length of hospital stay [10], and stoma creation, which is associated with poor quality of life [11]. Moreover, with both technical development and current literature offering strong clinical data on the effectiveness of SEMS including low complication and high success rates, preference for SEMS insertion for malignant colorectal obstruction has increased [10,12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

Yoon¹,

Park²,

Hong³

et al. 2013

Digestion

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Background/Aims: When re-intervention is required due to an occluded first colorectal self-expanding metal stent for malignant colorectal obstruction, serious controversies exist regarding whether to use endoscopic re-stenting or surgery. To compare the clinical outcomes in patients who underwent stent re-insertion versus palliative surgery as a second intervention. Methods: A total of 115 patients who received either self-expandable metal stent (SEMS) insertion or palliative surgery for treatment of a second occurrence of malignant colorectal obstruction after the first SEMS placement were retrospectively studied between July 2005 and December 2009. Results: The median overall survival (8.2 vs. 15.5 months) and progression-free survival (4.0 vs. 2.7 months) were not significantly different between the stent and surgery groups (p = 0.895 and 0.650, respectively). The median lumen patency in the stent group was 3.4 months and that in the surgery group was 7.9 months (p = 0.003). The immediate complication rate after second stent insertion was 13.9% and late complication rate was observed in 12 of 79 (15.2%) patients. There was no mortality related to the SEMS procedure. The complication and mortality rates associated with palliative surgery were 3.5% (2/57) and 12.3% (7/57), respectively. Conclusions: Although there is no significant difference in the overall survival between stenting and surgery, a secondary stent insertion had a lower mortality rate despite a shorter duration of temporary colorectal decompression compared to that of palliative surgery.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

Yoon¹,

Park²,

Hong³

et al. 2013

Digestion

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“…Placement of an expandable metallic stent has also been used as a logical method for palliation in patients unsuitable for curative surgery, not only because it avoids a palliative colostomy but also because it reduces hospital stays (17, 23, 24). In previous studies (7-12), there was high success rate in treating colorectal obstructions using metallic stents.…”

Section: Discussionmentioning

confidence: 99%

Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

et al. 2012

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ObjectiveTo evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction.Materials and MethodsThe study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients.ResultsA 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement.ConclusionThe placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

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Stents for Palliation of Obstructive Metastatic Colon Cancer

Karoui

Charachon²,

Delbaldo³

et al. 2007

Arch Surg

117

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Hypothesis:The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy.Design: A retrospective study.Setting: University tertiary care referral center. , 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with selfexpanding colonic metallic stent (SEMS) (n=31) or surgery (n=27). Main Outcome Measures:Comparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival.Results: Mortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5

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Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis

Cited by 184 publications

References 28 publications

Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

Stents for Palliation of Obstructive Metastatic Colon Cancer

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