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Inflammatory response to acute treatment of colonic obstruction due to colorectal malignancy, comparing colonic stenting and surgery.

Maria Bergstrom, Ramia Stolt, MD, Patrik Cikota, Roger Ahlen, Per-Ola Park. Dept of Surgery, South Alvsborg Hospital

Background: Any surgical trauma induces an inflammatory response, which is considered as a negative factor in the general immune response, specially in malignant disease. The C-Reactive Protein (CRP) is an acute phase protein often used as a marker of surgical trauma. Stent treatment has been used as a treatment option for colonic obstruction in palliative cases for many years, and also as a bridge to surgery in selected cases. In a pilot study we compared the inflammatory response after acute stent treatment or surgery for malignant colonic obstruction.

Method: We compared two consecutive series of treatment of acute malignant colonic obstruction, stent treatment or emergency surgery during 2011-2012. All patients were admitted with acute colonic obstruction due to colorectal cancer. Choice of treatment was based on attending senior colorectal surgeons’ preference, patient comorbidities and disseminated disease was considered. Patient age, CRP, time to first defecation and length of stay was recorded.

Results: A total of 31 patients were identified in a retrospective analysis. 15 patients had acute stent treatment and 16 had acute surgical treatment for colonic obstruction, all due to colorectal cancer. Median age was 77 y (30-95) with no difference between the groups. There was no difference in metastatic disease between the groups. Median time until first defecation after treatment was significantly shorter for the stented patients (39h (4-73)) compared with those operated (96h (24-168)) (p<0,001). Median hospital stay was also shorter in the stent group, 6 days (2-32), versus 11 days (7-30) in the surgical group (p=0,016). CRP did not differ between the groups before treatment. Both treatments resulted in increased CRP levels at postoperative days 1 and 2, but the CRP levels were significantly higher in the surgical group than in the stent group at both time points (POD 1 p=0,017, POD 2 p<0,001)

Conclusion: Acute stent treatment in colonic malignant obstruction seems to induce a less pronounced inflammatory response compared with surgery, as shown by a significantly reduced increase in postoperative CRP resulting in shorter time to first defecation and a shorter hospital stay.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88031

Program Number: P270

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

42

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