A Comparison of the Use of Self-Expanding Metallic Stent Insertion with Emergency Surgery as an Initial Treatment for Obstructive Colorectal Cancer

Suh, Jung Pil; Kim, Sang Woo; Paik, Chang Nyol; Park, Jae Myung; Cho, Yu Kyung; Lee, In Seok; Choi, Myung Gyu; Choi, Kyu Yong; Chung, In Sik; Kang, Won Kyung; Oh, Seong Taek

Abstract

BACKGROUND/AIMS: Emergency surgery for obstructive colorectal cancer is associated with a high rate of postoperative complications. The objective of this study is to investigate the clinical difference between the use of elective surgery after stent insertion, and the performance of emergency surgery as an initial treatment for colorectal cancer with an intestinal obstruction.
METHODS
For patients that were admitted from February 2004 to June 2006 for obstructive colorectal cancer, a retrospective analysis on the clinical outcome was performed for a group of patients that received a stent as an initial treatment (stent group) and a group of patients that received emergency surgery as an initial treatment (emergency operation group).
RESULTS
Postoperative complications in the stent group included pneumonia and wound infection (9.5%). For the emergency operation group, postoperative complications included sepsis, deep vein thrombosis, wound infection, anastomosis leakage and postoperative bleeding (38.9%). The number of postoperative complications were significantly less in patients in the stent group than for patients in the emergency operation group (p=0.032). The number of a one-staged operation was significantly higher in the stent group compared with the emergency operation group (85.7% vs 55.6%; p=0.039). The number of a stoma created at least once was significantly lower in the stent group (14.3% vs 50%; p=0.017) than in the emergency operation group.
CONCLUSIONS
As an initial treatment for an obstructive colorectal cancer, the use of stent insertion for primary management should be considered since it can reduce the degree of postoperative complications and the necessity for multi-staged operations.