Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis
Article first published online: 10 SEP 2007
Alimentary Pharmacology & Therapeutics
Volume 26, Issue 10, pages 1379–1386, November 2007
How to Cite
SIDDIQUI, A., KHANDELWAL, N., ANTHONY, T. and HUERTA, S. (2007), Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis. Alimentary Pharmacology & Therapeutics, 26: 1379–1386. doi: 10.1111/j.1365-2036.2007.03513.x
- Issue published online: 10 SEP 2007
- Article first published online: 10 SEP 2007
- Publication data Submitted 3 July 2007 First decision 17 July 2007 Resubmitted 27 July 2007 Second decision 7 August 2007 Resubmitted 4 September 2007 Accepted 5 September 2007
Background Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency.
Aim To compare the clinical outcomes and cost-effectiveness of endoscopic self-expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6-month period.
Methods Decision analysis was used to calculate the cost-effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort).
Results Self-expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6-month period. Colonic SEMS was also associated with a lower mean cost per patient ($27 225 vs. $57 398). Mortality in the surgery group was 25 times that of the SEMS cohort. One- and two-way sensitivity analyses identified SEMS as the dominant strategy.
Conclusion Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.