Outcome of Palliative Management of Malignant Large Bowel Obstruction w/Colorectal Stents or Surgery

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 othe…