Clinical

Stents for metastatic colon cancer improve survival, allow earlier chemotherapy

Last Updated: 2007-07-24 13:07:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - For patients with obstructive colon cancer that has metastasized, insertion of self-expanding metallic stents allows earlier initiation of chemotherapy, improves survival and may enable resection of metastases, French researchers report in the July issue of the Archives of Surgery.

Placement of a self-expanding metallic stents (SEMS) "should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases," advise Dr. Mehdi Karoui and colleagues at the Hopital Henri Mondor in Creteil, France.

These recommendations are based on a retrospective study of 58 patients with obstructing colon cancer and nonresectable metastases. Of these, 31 received SEMS and 27 underwent emergency surgery.

Morbidity and mortality were similar in the two groups. Median hospital stay was 8.0 days in the SEMS group and 13.5 days in the resected patients. Median survival was similar in the two groups, at 13.7 months with SEMS and 11.4 months for surgery.

Only 6% of patients with SEMS required creation of stomas compared with 37% of the surgery group, the report indicates.

Median time to chemotherapy was 14.0 days in the SEMS patients compared with 28.5 days in the surgical patients. Two of the SEMS patients undergoing chemotherapy had tumor perforations that required emergency surgery.

Three SEMS patients underwent curative colon and hepatic resection compared with none of the surgery group.

"This study suggests that SEMS is the option of choice in the initial management of patients with obstructing colon cancer and nonresectable metastases because it shortens the hospital stay, avoids a stoma in two-thirds of the patients, allows chemotherapy to be administered earlier, and has no detrimental effect on morbidity and survival," Dr. Karoui and colleagues write.

"The risk of tumor perforation while receiving more effective chemotherapy requires attention, and could lead to the consideration of palliative SEMS as a bridge to elective surgery for patients with stabilized or downstaged metastatic disease," they conclude.

Arch Surg 2007;142:619-623.