RCT of Colonic Stent Insertion vs. Surgical Decompression for Patients with Malignant Incurable Large Bowel Obstruction (#170)
There is emerging evidence for the role of self-expanding metallic stents for the treatment of large bowel obstruction (LBO). This study compared colonic stenting with surgical decompression for patients with an LBO.
Cancer patients with incurable LBO were randomized to surgery or stent insertion. Stoma rates, quality of life (QoL) (measured using the EuroQol EQ-5D and QLQ-CR29), procedure details, and survival, were compared between groups on an intention to treat basis.
52 patients were included in the analysis. 67% were male. 77% had colorectal cancer. Mean age was 66 years (SD=13). There were no stent related perforations or deaths. Stent insertion was successful in 19/26 (73%). The remaining 7/26 stent patients had a stoma formed, compared with 24/26 surgery patients (p < 0.001).
Surgery patients had significantly reduced EQ-5D QoL compared to stented patients from baseline to: 1 week (p = 0.001), 2 weeks (p = 0.01) and 12 months (p = 0.01). Differences in QLQ-CR29 symptom and functional scales were seen at 2 and 4 weeks between groups.
Stented patients had a 30 day mortality rate of 8% compared to 15% for surgery patients (p = 0.7). Median survival was 5.2 and 5.5 months for stent and surgery patients respectively (p = 0.6).
Stented patients had a reduced: procedure time (p = 0.01); post procedure stay (p = 0.01); days nil by mouth (p = 0.002); days before free access fluids (p = 0.001) and solids (p = 0.02); days to first flatus (p = 0.001) and bowel movement (p = 0.002), compared to surgery patients. Complication rates were not statistically different between groups (p = 0.1).
Use of metallic stents in patients with an incurable LBO has similar survival rates and QoL to surgical decompression. Benefits of metallic stents included faster return to diet, decreased stoma rates and reduced procedure stays.