Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction Journal Article


Authors: Nagula, S.; Ishill, N.; Nash, C.; Markowitz, A. J.; Schattner, M. A.; Temple, L.; Weiser, M. R.; Thaler, H. T.; Zauber, A.; Gerdes, H.
Article Title: Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction
Abstract: Background: Emergent surgical management of malignant large bowel obstruction (LBO) carries a high rate of morbidity and mortality. Self-expanding metal stents have emerged as an alternative for palliation of malignant LBO. However, there are few long-term studies documenting the effect of surgical palliation or colonic stents on symptoms or quality of life (QoL). Study Design: Between 2003 and 2006, patients with unresectable-for-cure malignancies presenting with LBO were enrolled in this prospective study. Patients elected to undergo stent placement or surgical palliation. Patients completed a symptom questionnaire and a QoL instrument (Functional Assessment of Cancer Therapy-Colorectal [FACT-C]) at weeks 1, 2, 4, 8, 12, and 24 after palliation. Symptoms were assessed using the Colon Obstruction Score, a novel instrument comprising nausea, vomiting, pain, distension, and bowel movement frequency scores. Results: Thirty patients had successful stent placement; 14 underwent surgical diversion. Colon Obstruction Scores immediately improved after both stent placement and surgery (p < 0.05 for all time points). Composite FACT-C scores progressively improved after stent placement (p = NS), with the colon symptoms subscale improving after 1 month (p < 0.05). FACT-C scores declined initially after surgery and then returned to baseline, with modest improvements seen in the Colon Symptoms subscale (p = NS). Conclusions: Both stent placement and surgical diversion provide durable improvement in symptoms from LBO, as readily assessed by the Colon Obstruction Score. QoL is difficult to assess in terminal cancer patients, but colon stent placement is associated with improved overall QoL and QoL related to gastrointestinal symptoms. © 2010 American College of Surgeons.
Keywords: adult; cancer survival; clinical article; middle aged; cancer surgery; cancer palliative therapy; colorectal cancer; palliative care; quality of life; cohort studies; neoplasm recurrence, local; nausea; vomiting; colorectal neoplasms; questionnaire; reoperation; stent; therapy effect; terminal care; intestine obstruction; intestinal obstruction; disease control; stents; defecation; intestine distension
Journal Title: Journal of the American College of Surgeons
Volume: 210
Issue: 1
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2010-01-01
Start Page: 45
End Page: 53
Language: English
DOI: 10.1016/j.jamcollsurg.2009.09.039
PUBMED: 20123331
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 20 April 2011" - "CODEN: JACSE" - "Source: Scopus"
Altmetric
Citation Impact
MSK Authors
  1. Hans Gerdes
    151 Gerdes
  2. Arnold J Markowitz
    113 Markowitz
  3. Satish Nagula
    8 Nagula
  4. Martin R Weiser
    385 Weiser
  5. Larissa Temple
    190 Temple
  6. Mark Schattner
    114 Schattner
  7. Ann G Zauber
    261 Zauber
  8. Howard T Thaler
    230 Thaler
  9. Nicole Marie Leoce
    86 Leoce