BACKGROUND: Acute left-sided malignant colonic obstruction is common in elderly patients and multiple treatment options exist. To date, the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described. AIMS: The purpose of this study was to compare mortality, avoidance of stoma, and short-term survival in elderly patients with malignant bowel obstruction treated with either colonic stenting or surgery. METHODS: In this retrospective review, elderly patients with acute left-sided colonic obstruction cancer underwent either insertion of a SEMS (n = 34) or primary surgery (n = 58). The two groups were compared for clinic variables, surgical procedures and outcome, acute mortality, and complications. RESULTS: Both groups were similar in terms of age, sex, tumor distribution, ASA grade, and comorbidities. The SEMS were successful placed in 91% of patients,and surgery was effective in relieving obstruction in 100% of the patients. Primary anastomosis was 79% in the SEMS group compared to 47% in the primary surgery group (P = 0.002). Secondary reanastomosis was 31% in the primary surgery group but only 3% in the SEMS surgery group (P = 0.001). Patients in the SEMS group had less 30-day mortality compared to the primary surgery group (3% vs. 19%, P = 0.03). Postoperative complications were similar. CONCLUSIONS: In elderly patients with acute left-sided colonic obstruction cancer due to colorectal cancer, SEMS provide an effective and safe therapeutic option compared to emergent surgery.
BACKGROUND: Acute left-sided malignant colonic obstruction is common in elderly patients and multiple treatment options exist. To date, the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described. AIMS: The purpose of this study was to compare mortality, avoidance of stoma, and short-term survival in elderly patients with malignant bowel obstruction treated with either colonic stenting or surgery. METHODS: In this retrospective review, elderly patients with acute left-sided colonic obstruction cancer underwent either insertion of a SEMS (n = 34) or primary surgery (n = 58). The two groups were compared for clinic variables, surgical procedures and outcome, acute mortality, and complications. RESULTS: Both groups were similar in terms of age, sex, tumor distribution, ASA grade, and comorbidities. The SEMS were successful placed in 91% of patients,and surgery was effective in relieving obstruction in 100% of the patients. Primary anastomosis was 79% in the SEMS group compared to 47% in the primary surgery group (P = 0.002). Secondary reanastomosis was 31% in the primary surgery group but only 3% in the SEMS surgery group (P = 0.001). Patients in the SEMS group had less 30-day mortality compared to the primary surgery group (3% vs. 19%, P = 0.03). Postoperative complications were similar. CONCLUSIONS: In elderly patients with acute left-sided colonic obstruction cancer due to colorectal cancer, SEMS provide an effective and safe therapeutic option compared to emergent surgery.
Authors: H S Tilney; R E Lovegrove; S Purkayastha; P S Sains; G K Weston-Petrides; A W Darzi; P P Tekkis; A G Heriot Journal: Surg Endosc Date: 2006-12-09 Impact factor: 4.584
Authors: G Folprecht; D Cunningham; P Ross; B Glimelius; F Di Costanzo; J Wils; W Scheithauer; P Rougier; E Aranda; H Hecker; C-H Köhne Journal: Ann Oncol Date: 2004-09 Impact factor: 32.976
Authors: Cristina Martinez-Santos; Rosa F Lobato; José Manuel Fradejas; Isabel Pinto; Pablo Ortega-Deballón; Mariano Moreno-Azcoita Journal: Dis Colon Rectum Date: 2002-03 Impact factor: 4.585
Authors: Gloria J Morris; Kristine Swartz; Andrew E Chapman; Stuart M Lichtman; Jason S Levitz; Farhad Ravandi; Kathryn R Chan Journal: Semin Oncol Date: 2012-10 Impact factor: 4.929