The Effect of Self-Expanding Metallic Stent Insertion for the Treatment ofMalignant Colorectal Obstruction

Korean J Gastrointest Endosc > Volume 36(5); 2008 > Article

Korean Journal of Gastrointestinal Endoscopy 2008;36(5): 274-281.

대장암에 의한 장 폐쇄 환자에서 자가팽창형 금속제 스텐트 삽입술의 효과에 대한 다기관 연구 -응급수술군과의 비교를 통한 임상 효과 및 의료 경제학적 분석을 중심으로-

이기명ㆍ김태일*ㆍ고봉민^†ㆍ신성재ㆍ김원호*ㆍ김진홍ㆍ이문성^†ㆍ김현수^‡ㆍ박영수^§ㆍ이강문^∥ㆍ박종재^¶ㆍ진윤태^¶

아주대학교 의과대학 내과학교실, *연세대학교 의과대학 내과학교실, ^†순천향대학교 의과대학 부천병원 내과학교실, ^‡연세대학교 원주의과대학 내과학교실, ^§서울대학교 의과대학 분당병원 내과학교실, ^∥가톨릭대학교 의과대학 빈센트병원 내과학교실, ^¶고려대학교 의과대학 내과학교실

The Effect of Self-Expanding Metallic Stent Insertion for the Treatment ofMalignant Colorectal Obstruction

Kee Myung Lee, M.D., Tae Il Kim, M.D.*, Bong Min Ko, M.D.^†, Sung Jae Shin, M.D., Won Ho Kim, M.D.*, Jin Hong Kim, M.D., Moon Sung Lee, M.D.^†, Hyun Soo Kim, M.D.^‡, Young Soo Park, M.D.^§, Ka

Department of Internal Medicine, Ajou University College of Medicine, Suwon, *Yonsei University College of Medicine, Seoul, ^†Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, ^‡Yonsei University Wonju College of Medicine, Wonju, ^§Seoul National University College of Medicine Bundang Hospital, Seongnam, ^∥The Catholic University of Korea College of Medicine, St. Vincent Hospital, Suwon, ^¶Korea University College of Medicine, Seoul, Korea

Abstract

Background/Aims:
The aim of this study was to evaluate the clinical and cost effectiveness of the use of stent insertion for malignant colorectal obstruction as compared with performing emergency surgery.
Methods:
We retrospectively reviewed the medical records of 201 patients. Malignant colorectal obstructions caused by a resectable tumor were treated with preoperative stenting followed by surgery (group A, n=55) or emergency surgery (group B, n=59). Malignant obstructions caused by an unresectable cancer were treated with palliative stenting (group C, n=58) or palliative emergency surgery (group D, n=29).
Results:
The one-staged radical resection rate was significantly higher in group A patients than in group B patients (87.3% vs. 52.5%, p＜0.05). Post-operative complications were more frequent in group A patients than in group B patients (9.1% vs. 32.2%, p＜0.05). The admission period was significantly shorter for group A patients than for group B patients (25.0 days vs. 33.7 days, p＜0.05). The medical cost was not different for group A and group B patients. Life-long stoma formation was necessary for 15.5% of group C patients and 69% of group D patients, respectively. The admission period was significantly shorter for group C patients than group D patients (10.5 days vs. 22.7 days, p＜0.05). The medical cost was not different for group C and D patients.
Conclusions:
Stent insertion was an effective treatment modality for malignant colorectal obstruction. (Korean J Gastrointest Endosc 2008;36:274- 281)

Key Words: Stent insertion, Malignant obstruction, Colon cancer

주요어: 스텐트 삽입, 악성 장 폐쇄, 대장암