Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients.

Background: Acute left-sided malignant colonic obstruction is common in elderly patients and multiple treatment options exist. To date, the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described.

Aims: The purpose of this study was to compare mortality, avoidance of stoma, and short-term survival in elderly patients with malignant bowel obstruction treated with either colonic stenting or surgery.

Methods: In this retrospective review, elderly patients with acute left-sided colonic obstruction cancer underwent either insertion of a SEMS (n = 34) or primary surgery (n = 58). The two groups were compared for clinic variables, surgical procedures and outcome, acute mortality, and complications.

Results: Both groups were similar in terms of age, sex, tumor distribution, ASA grade, and comorbidities. The SEMS were successful placed in 91% of patients,and surgery was effective in relieving obstruction in 100% of the patients. Primary anastomosis was 79% in the SEMS group compared to 47% in the primary surgery group (P = 0.002). Secondary reanastomosis was 31% in the primary surgery group but only 3% in the SEMS surgery group (P = 0.001). Patients in the SEMS group had less 30-day mortality compared to the primary surgery group (3% vs. 19%, P = 0.03). Postoperative complications were similar.

Conclusions: In elderly patients with acute left-sided colonic obstruction cancer due to colorectal cancer, SEMS provide an effective and safe therapeutic option compared to emergent surgery.