Colorectal cancer presents with malignant bowel obstruction in about 10% of cases. SEMS can be an alternative for immediate surgery but long-term data is limited regarding clinical outcomes and safety of BV in this subset of patients.
We performed a retrospective review of 2850 cases of colon cancer from January 2012 to October 2017, and identified metastatic patients with malignant bowel obstruction initially treated with SEMS or emergency surgery. Differences in procedure-related morbidity and overall survival (OS) were assessed.
We selected 119 cases, 79 treated with SEMS and 40 with surgery. Median age: 76. Median follow-up time: 11 months. No differences in sidedness or RAS status between cohorts. SEMS and surgery had a similar rate of complications (35.5% vs 32.5%, p = 0.45) and showed longer time to complications (18m vs 1m, p = 0.004). In patients treated with BV, complications were similar in SEMS and surgery (40% vs 31%, RR 1.28, p = 0.5) and perforation was also similar (13% vs 19%, RR 1.46, p = 0.4). The incidence of perforation in the SEMS group was similar between BV and chemotherapy alone (13% vs 9%, p = 0.2). In patients without systemic therapy, complications were higher in the surgery group compared to SEMS (50% vs 25%, RR 1.34, p = 0.1), also the incidence of perforation (20% vs 6%, RR 1.57, p = 0.2), but not statistically significant. SEMS and surgery showed similar OS (14m vs 15m, p = 0.5). Treatment with BV increased OS in SEMS group (18 months vs 7 months, p = 0.001) and surgery group (20 months vs 4 months, p = 0.001) compared to patients without subsequent medical treatment. In the multivariate analysis, patients treated with subsequent medical treatment showed a statistically significant longer OS [HR 0.43, CI95% 0.19-0.94, p = 0.02] and patients who had complications, showed a shorter OS (HR 2.45, CI95% 1.17-5.12, p = 0.01).
Bevacizumab-based therapy increased survival in metastatic colon cancer and, was not associated with a higher risk of perforation in patients with SEMS. Emergency surgery and SEMS showed a similar incidence of complications and perforations, with no differences between both strategies in patients treated with BV.
Clinical trial identification
Legal entity responsible for the study
Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa.
Has not received any funding.
All authors have declared no conflicts of interest.