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Colonic Stenting No Better Than Emergency Surgery

May be an alternative in some cases, but with caution for perforations that may spread cancer

MONDAY, March 14 (HealthDay News) -- Colonic stenting does not offer a decisive advantage over emergency surgery in patients with acute obstructive left-sided colorectal cancer, and may pose safety concerns, according to a study published online March 12 in The Lancet Oncology.

Jeanin E. van Hooft, M.D., from the University of Amsterdam in the Netherlands, and colleagues investigated whether colonic stenting has better health outcomes than emergency surgery in 98 patients with acute obstructive left-sided colorectal cancer. Between 2007 and 2009, 47 patients were randomly assigned to receive colonic stenting as a bridge prior to elective surgery and 51 were assigned to emergency surgery. Mean global health status during a six-month follow-up was the main outcome.

The investigators found increased 30-day morbidity in the colonic stenting group, with an absolute risk increase of 0.19 in two interim analyses. The study was suspended Sept. 18, 2009, following advice of the data safety monitoring committee. At the final follow-up there was no difference in overall mortality, 30-day mortality, morbidity, mean global health status, and stoma rates between the two treatment groups. The most common serious adverse events were perforations (six in stent group versus none in emergency surgery group), abscess (three versus none), anastomotic leakage (five versus one), pneumonia (three versus one), and wound infection (one versus three).

"Colonic stenting has no decisive clinical advantages to emergency surgery. It could be used as an alternative treatment in as yet undefined subsets of patients, although with caution because of concerns about tumor spread caused by perforations," the authors write.

Two study authors disclosed financial relationships with the pharmaceutical industry.

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