A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer.

摘要

INTRODUCTION: Untreated malignant large bowel obstruction is rapidly fatal. Short-term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma represents a significant burden for both patients and carers. Palliative endoluminal stenting may therefore be an attractive alternative option for this poor prognostic group. PATIENTS: Thirty-six patients were studied of whom 18 had obstructing left-sided colon cancer relieved by placement of endoluminal stents. These were compared with 18 historical controls with similar clinicopathological features that were treated more conventionally with palliative stoma formation in the same hospital. RESULTS: Patients in the two groups had similar sex distribution (P = 0.5); however, patients undergoing palliative stoma formation were significantly younger than patients being stented (P = 0.0065). As well as being older, there was a trend towards greater co-morbidities, stent patients having higher ASA grades (P = 0.01). Both groups of patients gained relief of obstructive symptoms. There were no differences in survival (P = 0.5) or in hospital mortality (2 in each group). The median length of palliation is 92 days (42-infinity days) for stenting and 121 days (89-281 days) for palliative stoma formation. Formation of a stoma required a significantly longer stay in ITU (P = 0.003) but total hospital stay was similar. CONCLUSIONS: As an alternative to palliative surgery, selected patients benefit from colonic endoluminal stenting with relief of obstructive symptoms and no adverse effect on survival. They may be spared the potential problems associated with palliative stoma formation and the morbidity of surgery. Stenting can be offered to the very frail patient who would otherwise be managed conservatively.