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Impact on Management and Chemotherapy Administration

Mehdi Karoui, MD, PhD; Antoine Charachon, MD; Catherine Delbaldo, MD; Jérome Loriau, MD; Alexis Laurent, MD, PhD; Iradj Sobhani, MD; Jeanne Tran Van Nhieu, MD; Jean Charles Delchier, MD; Pierre-Louis Fagniez, MD; Pascal Piedbois, MD, PhD; Daniel Cherqui, MD

Arch Surg. 2007;142(7):619-623.

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.

Patients  From January 1, 1996, to September 15, 2005, 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with self-expanding 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 days, respectively; P < .01). Incidence of stoma creation was lower in patients treated with SEMS than in patients treated with surgery (6% vs 37%, respectively; P = .02). The median time to chemotherapy administration was shorter after SEMS insertion than after surgery (14.0 vs 28.5 days, respectively; P = .002). Three patients with SEMS and 0 patients in the surgical group underwent a curative colonic and hepatic resection after downstaging by chemotherapy (P = .27). Two patients (6%) with SEMS and undergoing chemotherapy had a tumor perforation requiring emergency surgery. There was no difference in survival between the 2 groups (median survival, 13.7 months for SEMS vs 11.4 months for surgery; P = .19).

Conclusions  Insertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention.

Author Affiliations: Departments of Surgery (Drs Karoui, Loriau, Laurent, Fagniez, and Cherqui), Gastroenterology (Drs Charachon, Sobhani, and Delchier), Medical Oncology (Drs Delbaldo and Piedbois), and Pathology (Dr Tran Van Nhieu), Hôpital Henri Mondor, Créteil, France.

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