Treating Bowel Obstruction Due to Colon Cancer

Comparing Stents and Surgery: Which Is Best?

oncologists looking at MRI
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In cases of advanced colon cancer, there are times when a tumor cannot be removed. It is an unfortunate and complicated situation, and one that is often fraught with emotion and uncertainty.

For anyone faced with an inoperable tumor, it’s important to remember that people can, in fact, live for years wit advanced cancer, It doesn’t mean that everyone should suddenly give up because a tumor is operable.

In more cases than not, it’s just the opposite.

The main goal in situations like this is to make sure symptoms are managed and that the person is able to maintain the best quality of life possible even if the cancer is not curable.

One of the possible complications of end-stage cancer is that the colon can become blocked by a tumor. This is called malignant obstruction. Fortunately, doctors can treat this condition in two different ways:

  • Surgery to either divert or bypass the obstruction
  • Placement of a stent (a slender flexible tube) to help support the opening of a passage

Stent vs. Surgery for Malignant Obstruction

For a person experiencing a malignant obstruction, choosing between a full surgery or the placement of a stent placed can often be difficult. To many, a stent will seem the obvious choice. After all, stents can be placed relatively easily, often with minimally invasive laparoscopic surgery and far shorter recovery time.

But is easier always the right answer?

A 2011 study published in the journal Gastrointestinal Endoscopy posed just this question. According to the report, 144 people with advanced colon cancer underwent treatment to correct a malignant obstruction of which half had surgery; the other half had a stent.

In reviewing the short- and long-terms results, key difference began to emerge:

  • Overall, the short-term success rates for stents and regular surgery were not significantly different. Both procedures worked well to treat a blocked colon.
  • During early recovery, the group that had received stents had approximately half the rate of early complications in the surgery group (15.5 versus 32.9 percent, respectively).
  • However, as recovery progressed, the period of time that the blockage remained clear was far shorter in the stent group, with some people even requiring a second stent.
  • Over the long term, while the rate of major complications was more or less the same for both groups, the stent group had significantly more late complications compared to the surgery group.

Making Your Best Possible Choice

If you or a loved one is faced malignant obstruction, you may be forced to choose between surgery or a stent as a matter of urgency. An obstruction like this is a serious medical condition that demands immediate attention to avoid ruptures and any other potentially life-threatening complication.

With that being said, a quick decision doesn't have to be an uninformed one. You simply need to weigh the pros and cons based on some general understandings:

  • While a stent may be a quicker fix for a blocked colon, the chances of needing another are higher when compared to surgery.
  • While surgery tends to offer longer-lasting results, it also requires a longer healing time with a greater risk of short-term complications.

Work with your oncologist and surgeon to figure out the best option for the individual involved. This may include a review of the person's age, general health, emotional state, and other factors that can suggest how well the person will tolerate a procedure and recover from it.

There is no right or wrong decision if you have been given all the information needed to make an informed choice.

Source:

Lee, H.; Hong, S.; Cheon, J.; et al. "Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery." Gastrointestinal Endoscopy. 2011; 73(3):535-542.

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