Management of acute large bowel obstruction due to colorectal cancer: Diversion colostomy versus stent placement

Abstract

Background and Aim: Colonic stenting is a novel and
privileged therapeutic option for malignant obstructions
of the large bowel, especially as a bridging procedure to
elective surgery. The aim of this retrospective study was to
compare the efficacy of the traditional surgical approach
with stent placement in the management of obstructing
colorectal tumours. Patients and Methods: Thirty-three
patients with malignant colonic obstruction were retrospectively
studied. Of them, 17 underwent a diversion colostomy
(group I), while 16 were treated with SEMS (group II). Early
outcome, late outcome and duration of hospitalisation were
evaluated. For statistical analysis chi-square and Student.s
t-test were used (statistical significance level P<0.05).
Results: One death in each group occurred within the first
3 days following colonic decompression. One case of pulmonary
embolism (group I) and one case of asymptomatic
colonic perforation (group II) were the only early morbid
situations complicating decompressing interventions.
Elective surgery was finally performed on 10 patients in
group I and in 9 patients in group II. One case of early
local recurrence after tumor resection was observed in the
stenting group. The cumulated mortality rate was estimated
at 6.9% and 9.1 % and cumulated morbidity rate at 20.7%
and 9.1% for the two groups respectively. The mean time of
hospitalization was significantly longer in the colostomy group. Conclusions: SEMS are effective for the temporary
treatment of malignant occlusions of the large bowel and
particularly advantageous not only because of their
technical simplicity but also good tolerance and quality of
life which they offer epecially in cases of locally or distally
extended disease.