Quality of Life and Symptom Control after Stent Placement or Surgical Palliation of Malignant Colorectall Obstruction

BACKGROUND: Emergent surgical management of malignant large bowel obstruction (LBO) carries a high race 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 stem placement; 14 underwent surgical diversion. Colon Obstruction Scores immediately improved after both stem placement and surgery (p < 0.05 for all time points). Composite FACT-C scores progressively improved after stem 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 stem 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 stem placement is associated with improved overall QoL and QoL related to gastrointestinal symptoms. (J Am Coll Surg 2010;210:45-53. (C) 2010 by the American College of Surgeons)