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Invited Critique
July 1, 2007

Stents for Palliation of Obstructive Metastatic Colon Cancer—Invited Critique

Arch Surg. 2007;142(7):623. doi:10.1001/archsurg.142.7.623

Dr Karoui and colleagues present a timely, thought-provoking study comparing SEMS with operative management in the setting of obstructing colon cancer with unresectable distant disease. Their experience with this technique further underscores the potential efficacy, safety, and equivalency compared with palliative surgery.1 However, their enthusiasm stems mostly from demonstrating a significant benefit with decreased hospital stay, stoma formation, and time to chemotherapy—hence, less morbidity. Their proposed paradigm shift from palliative surgery to a less-is-more or bridging-treatment approach appears more relevant when considering that (1) palliative surgery delays administering systemic chemotherapy; (2) recent advances with systemic therapies have improved median survivals approaching 2 years; and (3) operative salvage can be offered in select patients with demonstrable tumor regression (downstaging) or without tumor progression—a distinct survival advantage.2-4

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