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Stenting or Straight to Surgery for Acute Obstruction in Stage IV Colorectal Cancer?

By: Celeste L. Dixon
Posted: Monday, November 5, 2018

To address the controversy over whether endoscopic stenting or emergency surgery is better for patients with stage IV colorectal cancer presenting with acute large bowel obstruction, a retrospective review of 66 patients who underwent either procedure was performed by colorectal surgeon Ker-Kan Tan, MBBS, FRCS, of the National University Health System, Singapore, and colleagues. The results: “Stenting is a safe option,” the researchers wrote in the Journal of Gastrointestinal Oncology.

“Patients who had successful stenting had the best outcomes, [while those] who failed stenting and required emergency surgery did not fare worse when compared with these patients who had upfront emergency surgery,” the investigators reported.

Between January 2007 and June 2014, 40 of the patients underwent endoscopic stenting to start; 26 had initial emergency surgery. A total of 29 patients underwent successful stenting and the remaining 11 patients did not; those who had unsuccessful stenting required immediate emergency surgery to relieve the obstruction.” Dr. Tan and colleagues noted there was no difference in the rates of stoma creation between those who had emergency surgery and those who had successful stenting.

Of note, patients whose stenting was successful began chemotherapy earlier than those who had upfront surgery (P = .02). In part, response to “chemotherapy often…determines [patients’] prognosis, [and] the timing of chemotherapy administration is largely dependent on how early the patient can recover from the insult of the acute presentation,” the authors stated.

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