Stent Placement Reduces Need for Stoma in Some Colorectal Cancers

The placement of a stent as initial emergency treatment for colon obstruction reduces the need for a stoma without adversely affecting outcomes for patients with potentially curable colorectal cancer. These results were recently presented at the 2016 annual meeting of the American Society of Clinical Oncology (ASCO).

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Since there are often no signs or symptoms of colorectal cancer until advanced stages, 20% of colorectal cancer patients initially find out they have the disease from complications requiring emergency treatment. Of these, 80% have an obstruction of their colon.

Historically, patients requiring emergency treatment would undergo surgery to relive the obstruction. This surgery would often result in patients requiring a stoma. The surgical procedure resulting in a stoma requires the removal of a large portion of the colon containing the obstruction. The end of the colon remaining in the body is then attached to the abdominal wall. A hole, or stoma, is created at this attachment site so that waste can be expelled to the outside of the body. A removable bag is attached to the stoma to collect the waste. Although effective, living with a stoma can significantly alter a person’s lifestyle (particularly during the beginning adjustment period), including the learning of new dietary habits, changing bags, lifetime costs, etc.

Researchers recently conducted a clinical trial to determine the effectiveness of a stent as initial emergency treatment to resolve the colon obstruction among patients with colorectal cancer. The trial included 246 patients with potentially curable colorectal cancer who sought emergency care due to an obstruction in their colon.

One group of patients was treated with a metal stent (a small hollow tube placed in the colon to resolve the obstruction), and one group of patients was treated with standard emergency surgery to resolve the obstruction. All patients underwent subsequent treatment for their cancer, 92% of whom underwent treatment with curative intent.

Stents achieved relief of obstruction in 82% of patients.
69% of patients undergoing emergency surgery ultimately required a stoma, compared with only 45% of patients initially treated with a stent.
Survival at one year, critical care utilization, mortality at 30 days following surgery as treatment for their cancer, or quality of life issues were similar between the two groups of patients.

The researchers concluded that “In patients fit enough to undergo surgery, stenting as a bridge to surgery reduced stoma formation without a detrimental effect on one-year survival. Post-operative mortality, length of hospital stay, critical care usage and Quality of Life were not different between the two treatment groups.”

Reference: Hill J, Kay C, Morton D, et al. CREST: Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer—Results of the UK ColoRectal Endoscopic Stenting Trial (CREST). Proceedings from the 2016 ASCO meeting. Abstract #3507. Available at: http://meetinglibrary.asco.org/content/169602-176. Accessed June 18, 2016.

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