Outcome of Palliative Management of Malignant Large Bowel Obstruction w/Colorectal Stents or Surgery
Outcome of Palliative Management of Malignant Large Bowel Obstruction w/Colorectal Stents or Surgery
The purpose of this study is to assess quality of life and bowel symptoms after treatment.The
 main objective is to compare the effect on quality of life of minimally invasive bowel
 surgery and endoscopic stent placement in the treatment of malignant large bowel obstruction.
Large bowel obstruction is a common presentation among cancer patients, including those with
 non-colorectal malignancies. This study will evaluate patients with malignant large bowel
 obstruction who undergo palliative treatment with minimally invasive surgical diversion or
 endoscopic colorectal stent placement, in terms quality of life, symptom relief from bowel
 obstruction, and treatment-related complications. Assessments in changes in quality of life
 and symptom relief over time for each group will be done.

 Traditionally malignant bowel obstruction is treated with surgery. In the last decade,
 creation of an ostomy can be completed with minimally invasive surgery, which reduces
 morbidity, mortality, and recovery time.wishes.

 In the last several years, endoscopically inserted colorectal stents have emerged as an
 option for palliative treatment. This involves a simple procedure, often completed on an
 outpatient basis. This allows the intestinal lumen to remain open without the need for
 surgery.

 -  Primary Objective: is to compare the effect on quality of life of minimally invasive
 surgical bowel diversion and endoscopic stent placement in the treatment of malignant
 large bowel obstruction.

 -  Secondary Objectives: are to evaluate the symptom response (including abdominal pain,
 distention, bowel frequency and consistency, and nausea and emesis) and complication
 rate of treatment of malignant large bowel obstruction with endoscopic stent placement
 or minimally invasive surgical bowel diversion.
Inclusion Criteria:

 -  men and women over 18 years of age

 -  presentation of large bowel obstruction based on clinical symptoms AND an imaging
 study.

 -  clinical symptoms: one of : progressive constipation, multiple small liquid bowel
 movements daily, abdominal distention, abdominal pain or nausea and vomiting.

 -  imaging study: one of: CT scan, barium or gastrograffin enema, flexible sigmoidoscopy
 or colonoscopy, showing any degree of colonic narrowing by tumor.

 -  large bowel obstruction due to stage IV colorectal cancer unresectable for cure OR
 unresectable local-regional colorectal cancer OR unresectable extra-colonic cancer
 (such as gastric, ovarian, prostate, pancreatic cancers).

 -  ability to give informed consent, indicating the investigational nature of this study
 in keeping with the policies of Memorial Sloan-Kettering Cancer Center.

 Exclusion Criteria:

 -  presence of acute bowel perforation

 -  presence of a second synchronous large or small bowel obstruction site

 -  contra-indication to stent placement:

 -  obstruction greater than 12 cm in length (ie precluding treatment with one stent)

 -  obstruction located within 2 cm of dentate line

 -  contra-indication to laparoscopy:

 -  presence of MI, unstable angina, or CVA in the previous four weeks

 -  tense ascites

 -  uncorrectable coagulopathy

 -  prior abdominal surgery with known prohibitive adhesions

 -  prior PALLIATIVE treatment of malignant large bowel obstruction with surgery or stent

 -  inability to speak or read English, or other impairment which causes an inability to
 complete the quality of life questionnaires

 -  unable or unwilling to give informed consent