Palliative colonic stenting: a safe alternative to surgery in stage IV colorectal cancer

Background: The morbidity associated with surgery for obstructing or nearobstructing stage IV colorectal cancer can be high including the frequent need for a stoma. Self-expandable metal stents (SEMS) offer an alternative to surgery. Our aim was to analyse our palliative SEMS outcomes and compare this with a palliative surgery group. Methods: A retrospective study of a single institutions' experience with SEMS or surgery in the management of stage IV colorectal cancer was performed. Results: Sixty-five patients treated with SEMS were included in the study. These were compared with an unmatched group of 63 patients who underwent surgery. Within the SEMS group was a 98.5% technical success and 100% clinical success of deployed SEMS. Overall complication rate was low at 23.1% (restenosis 7.7%, migration 7.7%, perforation 4.6% and bleeding 3.1%). Only 7.7% of patients in the SEMS group required an operation. SEMS insertion was associated with a shorter hospital stay (2.9 days versus 14.6 days; P < 0.001) and reduced requirement for a stoma (4.6% versus 44.4%; P < 0.001). There was no statistically significant difference in 30-day mortality (13.8% versus 11.1%; P = 0.640), 1-year survival (42.9% versus 41.4%; P = 0.949) or 2-year survival (24.5% versus 21.4%; P = 0.700). Overall survival was equivalent between the two groups (hazard ratio 1.27; 95% confidence interval 0.881.88; P = 0.212). Conclusion: SEMS is a safe alternative to surgery in obstructing or near-obstructing stage IV colorectal cancer. It offers high success rate, a shorter hospital stay and a reduced stoma rate while not impacting overall survival.