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The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic colorectal cancer

 Hyun Jung Lee  ;  Soo Jung Park  ;  Byung So Min  ;  Jae Hee Cheon  ;  Tae Il Kim  ;  Nam Kyu Kim  ;  Won Ho Kim  ;  Sung Pil Hong 
 DISEASES OF THE COLON & RECTUM, Vol.57(6) : 694-699, 2014 
Journal Title
Issue Date
Adult ; Aged ; Colectomy*/adverse effects ; Colonoscopy ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/surgery* ; Female ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestinal Obstruction/therapy* ; Intestinal Perforation/etiology* ; Intestinal Perforation/surgery ; Male ; Middle Aged ; Ostomy ; Prosthesis Failure/adverse effects ; Recurrence ; Reoperation ; Risk Factors ; Stents/adverse effects*
Colorectal neoplasms ; Malignant obstruction ; Self-expandable metal stents ; Primary colectomy ; Stoma
BACKGROUND: Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications. OBJECTIVE: The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful stenting in patients with obstructive metastatic colorectal cancer. DESIGN: This was a tertiary-care center retrospective study. PATIENTS: From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful stenting. INTERVENTIONS: Self-expandable metal stent placement and primary colectomy were performed. MAIN OUTCOME MEASURES: The stoma formation rate and complications were measured. RESULTS: In patients with successful stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful endoscopic stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04). LIMITATIONS: This was a retrospective, single-center study. CONCLUSIONS: To reduce stent-related late complications, primary colectomy after successful endoscopic stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
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
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Park, Soo Jung(박수정)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hong, Sung Pil(홍성필)
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