In an article first published online, Dr Peter W. G. Carne and colleagues from the Colorectal Unit in the Department of Surgery at Christchurch Hospital in Christchurch, New Zealand have compared the use of expandable metallic stents as a palliative measure to traditional open surgical management.
Their study, which looked at the use of such stents in patients with incurable metastatic colorectal adenocarcinoma, made particular reference to both length of stay and patient survival.
Dr Carne and his co-authors carried out their retrospective study on patients admitted between 1997 and 2002 with left-sided (splenic flexure and distal) colorectal adenocarcinoma and non-resectable metastatic disease (Stage 4).
Patients were treated with expandable metal stents or open surgery; resection, bypass, or stoma.
Those patients with stents inserted were compared with regard to perioperative outcome and survival to those having open surgery.
In total, 22 of 25 patients had colonic stents successfully inserted, while 19 patients underwent open surgery. Both groups were comparable in terms of age and gender (stent group 12 males, open operation 13 males).
|Patients treated with stents are discharged earlier than after open surgery|
|Diseases of the Colon & Rectum|
The tumors were primary in 22 stents procedures and 18 open operations.
The site of obstruction was: splenic flexure, 2 stent vs. 0 open operation; descending colon, 2 stent vs. 2 open operation; sigmoid colon, 12 stent vs. 6 open operation; rectum, 9 stent vs. 11 open operation.
The American Society of Anesthesiologists (ASA) class was: ASA 1, 0 stent vs. 0 open operation; ASA 2, 6 stent vs. 9 open operation; ASA 3, 15 stent vs. 7 open operation; ASA 4, 4 stent vs. 3 open operation.
The open operations were laparotomy only (2), bypass (1), stoma (7), resection with anastomosis (4) and resection without anastomosis (5).
The complications after open operation were urinary (2), stroke (1), cardiac (2), respiratory (2), deep vein thrombosis (1), anastomotic leak (1). There were no stent-related complications.
The mean length of stay was significantly shorter in the stent group (4 vs. 10.4 days) but there was no difference in survival between the two groups (median survival: stent group, 7.5 months; open operation, 3.9 months).
"Our study shows that patients treated with stents are discharged earlier than after open surgery and do not affect survival," said Dr Carne.
He added, "Expandable metal stents provide an acceptable alternative and may be better than traditional open surgical techniques."