• Mehdi Karoui, Antoine Charachon, Catherine Delbaldo, Jérome Loriau, Alexis Laurent, Iradj Sobhani, Tran Van NhieuJeanneJ, Jean Charles Delchier, Pierre-Louis Fagniez, Pascal Piedbois, and Daniel Cherqui.
• Department of Surgery, Service de Chirurgie Digestive, Hôpital Henri Mondor, 51 av du Maréchal de Lattre-de-Tassigny, 94010 Créteil CEDEX, France. mehdi.karoui@hmn.aphp.fr
• Arch Surg Chicago. 2007 Jul 1; 142 (7): 619-23; discussion 623.

HypothesisThe more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy.DesignA retrospective study.SettingUniversity tertiary care referral center.PatientsFrom January 1, 1996, to September 15, 2005, 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with self-expanding colonic metallic stent (SEMS) (n = 31) or surgery (n = 27).Main Outcome MeasuresComparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival.ResultsMortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5 days, respectively; P < .01). Incidence of stoma creation was lower in patients treated with SEMS than in patients treated with surgery (6% vs 37%, respectively; P = .02). The median time to chemotherapy administration was shorter after SEMS insertion than after surgery (14.0 vs 28.5 days, respectively; P = .002). Three patients with SEMS and 0 patients in the surgical group underwent a curative colonic and hepatic resection after downstaging by chemotherapy (P = .27). Two patients (6%) with SEMS and undergoing chemotherapy had a tumor perforation requiring emergency surgery. There was no difference in survival between the 2 groups (median survival, 13.7 months for SEMS vs 11.4 months for surgery; P = .19).ConclusionsInsertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention.

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