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Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

Authors
 Yoon J.Y.  ;  Park S.J.  ;  Hong S.P.  ;  Kim T.I.  ;  Kim W.H.  ;  Cheon J.H. 
Citation
 DIGESTION, Vol.88 : 46-55, 2013 
Journal Title
 DIGESTION 
ISSN
 0012-2823 
Issue Date
2013
MeSH
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/surgery* ; Digestive System Surgical Procedures* ; Female ; Humans ; Intestinal Obstruction/mortality ; Intestinal Obstruction/surgery* ; Male ; Middle Aged ; Palliative Care ; Postoperative Complications ; Retrospective Studies ; Stents* ; Survival Rate ; Treatment Outcome
Keywords
Stent failure ; Secondary stent ; Palliative surgery ; Colorectal obstruction
Abstract
BACKGROUND/AIMS: When re-intervention is required due to an occluded first colorectal self-expanding metal stent for malignant colorectal obstruction, serious controversies exist regarding whether to use endoscopic re-stenting or surgery. To compare the clinical outcomes in patients who underwent stent re-insertion versus palliative surgery as a second intervention. METHODS: A total of 115 patients who received either self-expandable metal stent (SEMS) insertion or palliative surgery for treatment of a second occurrence of malignant colorectal obstruction after the first SEMS placement were retrospectively studied between July 2005 and December 2009. RESULTS: The median overall survival (8.2 vs. 15.5 months) and progression-free survival (4.0 vs. 2.7 months) were not significantly different between the stent and surgery groups (p = 0.895 and 0.650, respectively). The median lumen patency in the stent group was 3.4 months and that in the surgery group was 7.9 months (p = 0.003). The immediate complication rate after second stent insertion was 13.9% and late complication rate was observed in 12 of 79 (15.2%) patients. There was no mortality related to the SEMS procedure. The complication and mortality rates associated with palliative surgery were 3.5% (2/57) and 12.3% (7/57), respectively. CONCLUSIONS: Although there is no significant difference in the overall survival between stenting and surgery, a secondary stent insertion had a lower mortality rate despite a shorter duration of temporary colorectal decompression compared to that of palliative surgery.
Full Text
http://www.karger.com/Article/FullText/351208
DOI
10.1159/000351208
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Park, Soo Jung(박수정)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hong, Sung Pil(홍성필)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87138
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