Self-expandable metal stent placement versus emergency resection for malignant proximal colon obstructions.

Background: Traditionally, all patients with a malignant obstruction of the proximal colon (MOPC) are treated with emergency resection. However, recent data suggest that Self-expandable metallic stent (SEMS) placement could lower mortality and morbidity rates. This study therefore aimed to compare SEMS placement with emergency resection as treatment options for MOPC.

Methods: All consecutive patients that underwent SEMS placement for MOPC in the period 2004-2015 at our institution were identified. SEMS placement was the standard of care for colonic obstructions at our institution in that period. All included SEMS patients were matched (1:4) on age (±5 years), gender, ASA-score, tumor location, surgical approach and pTNM-stage with patients treated by emergency resection. Controls were selected from a national database that prospectively registers all patients undergoing surgery for colorectal cancer in the Netherlands.

Results: In total, 41 patients received SEMS placement for MOPC. In 19 patients SEMS served as a definite palliative measure and in 22 as bridge to surgery. Technical and clinical success rates of SEMS placement were 92.7% and 90.2%, respectively. No significant differences between the SEMS and emergency resection group were found regarding morbidity and mortality rates, the number of radical resections and the number of primary anastomoses. Patients treated with SEMS were, however, less likely to have a temporary stoma constructed (p = 0.04). No SEMS-related complications occurred in patients in whom SEMS was placed as bridge to surgery, whereas one stent-related perforation, three stent migrations, and five stent re-obstructions were observed in the palliative group. Three re-obstructions could be treated with re-stenting, but all other SEMS-related complications required surgical intervention. In the palliative group, SEMS complications necessitating surgery occurred in 31.6% of the patients (6/19).

Conclusion: SEMS placement for MOPC appears to be a relatively feasible and safe alternative for emergency resection in both the curative and palliative setting.