Good survival outcomes in patients who undergo bowel resection after stent failure in malignant bowel obstruction

Volume : VIII, Issue : VI, June - 2018

Salman E Ahmed, Ali Ghareeb, Nick Wadd, Madan Jha

Background Colonic stents are inserted to relieve malignant obstruction. The longer the colonic stent remains in situ the

greater the risks of complication. In this study, we aim to investigate the overall outcomes in patients with unresectable

colorectal metastatic cancer being treated with colonic stents with or without palliative chemotherapy.

Methods This retrospective study was conducted in a tertiary oncology centre. All patients with an obstructing large bowel malignancy who had

colonic stents inserted between August 2005 and April 2015 were included and followed up until death. The primary outcome measure was

median survival.

Results Stenting was attempted in 84 patients with large bowel obstruction, 72 (85.7%) of which were successful. Sixty–four (76.2%) of the

attempted stents were palliative. Of these, twenty–eight patients with inoperable disease were stented and later received palliative chemotherapy,

while thirty–six patients were found to have poor performance status and were unsuitable for any form of chemotherapy. Median survival for

these groups was 235 days (95% CI: 165–330 days) and 121 days (63–328 days), respectively. Five patients in the chemotherapy group

underwent bowel resection. Median survival was found to be significantly higher at 560 days as compared to all other patients who received

chemotherapy (n=24), for whom median survival was 210 days (p=0.002).

Conclusions The survival of patients who receive bowel resection after stent failure is higher than that of patients who retain the stent. For

patients with suitable physical status, expected to survive more than 12 months and presenting with colonic obstruction, colostomy or surgical

resection of the primary may be a suitable alternative to stent and this should be investigated in future prospective trials.