• Won-Suk Lee, Jeong-Heum Baek, Jin Mo Kang, Sangtae Choi, and Kwang An Kwon.
• Department of Surgery, Gil Medical Center, Gachon University, School of Medicine, Incheon, Korea.
• Am. J. Surg. 2012 Jun 1; 203 (6): 715-9.

BackgroundIt is still a matter of debate as to whether palliative resection of obstructive primary tumors may prolong the survival of patients with obstructive colon cancer and unresectable synchronous metastases. The main goal of this retrospective study was to compare the use of self-expanding metallic stents (SEMS) with open surgery for the palliation of patients with respect to survival, morbidity, and the time to start chemotherapy.MethodsBetween January 2000 and January 2008, 88 consecutive patients (52 who underwent surgery and 36 who underwent SEMS insertion) with obstructive colon cancer and unresectable synchronous metastases were retrospectively evaluated.ResultsThe median hospital stay for all admissions was 7.2 days (range, 3-29 days) in the SEMS group and 12.3 days (range, 6-45 days) in the surgery group (P = .001). The incidence of stoma formation was significantly lower in the SEMS group than in the surgery group (16.7% vs 38.5%, respectively, P = .021). The median time to starting chemotherapy was significantly shorter in patients who underwent SEMS insertion compared with those who underwent surgery (8.1 vs 21.7 days, respectively, P = .001). The 1-year and 2-year survival rates were 44.2% and 21.27% in the surgery group and 16.7% and 2.8% in the SEMS group, respectively. The median survival for all patients was 15 months from the initiation of treatment (95% confidence interval, 6.0-19 months).ConclusionsBoth procedures can be safely performed, but the choice of treatment should be individualized and discussed with a multidisciplinary team.Copyright © 2012 Elsevier Inc. All rights reserved.

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