Usefulness and Cost-effectiveness of Colorectal Stent Followed by Curative Resection for Left-sided Malignant Colorectal Obstruction

Yoon, Soon Man; Byeon, Jeong Sik; Kim, Jong Wook; Kim, Do Hoon; Do, Mi Young; Kim, Byunggyu; Kwon, Seunghyun; Ye, Byong Duk; Myung, Seung Jae; Yang, Suk Kyun; Kim, Hee Cheol; Yu, Chang Sik; Kim, Jin Cheon; Kim, Jin Ho

Abstract

BACKGROUND/AIMS: We aimed to evaluate the cost-effectiveness of preoperative stent insertion for treating left-sided malignant colorectal obstruction.
METHODS
Patients with left-sided malignant colorectal obstruction were included in this study. The stent group (ST, n=24) included those patients who were treated with preoperative stent insertion followed by curative surgical resection. The clinical course and management cost of the ST group was compared to those of the emergency operation group (EO, n=22).
RESULTS
The patients' age (60.6+/-3.1 yrs vs. 62.1+/-3.2 yrs, p=0.74) and the male to female ratio (12:12 vs. 15:7, p=0.25) were not different between the ST and EO groups. The distribution of the postoperative pathologic stages was also not different. All the patients in the ST group underwent only one surgical operation, while 6 patients (27.3%) in the EO group underwent 2 or more surgeries (p<0.01). The mean hospital stay in the ST group was 22.0+/-0.8 days compared to 26.3+/-2.4 days in the EO group (p=0.09). Postoperative care in the intensive care unit was necessary for one patient (4.2%) in the ST group, while 7 patients (31.8%) in EO group needed postoperative care (p=0.02). Postoperative complications developed in one patient in the ST group, while 6 patients in the EO experienced postoperative complications (p=0.04). The mean total cost per patient was 7,974,236 won for the ST group while this was 9,271,630 won for the EO group (p=0.06).
CONCLUSIONS
Preopreative stent insertion for treating left-sided malignant colorectal obstruction is more cost-effective than an emergency operation.