COLONIC STENT FOR MALIGNANT OBSTRUCTION

Short of resection, palliative emergency stenting appears superior to stoma creation in patients with colorectal cancer and malignant large-bowel obstruction, according to New York-based researchers.

As Dr. Art Sedrakyan told Reuters Health by email, "Our study indicates that colonic stents improve the efficiency of care and quality of life of many terminally ill patients. There is a need to further advance this beneficial technology so that it can be more applicable to wider group of patients with colorectal cancer."

In a January 11 online paper in JAMA Surgery, Dr. Sedrakyan and colleagues at New York-Presbyterian Hospital note that while there has been strong support for palliative colonic stenting to manage colonic obstructions, its safety has been questioned and most studies have been small.

To investigate further, the researchers analyzed data from 2009 through 2013 on 172 patients who underwent bowel stenting and 173 who had stoma creation alone.

They note that about 60% of stenting patients were treated at high-volume centers, "meaning that our results are heavily weighted toward more experienced endoscopists. Generalization of our results to centers without experienced endoscopists should therefore be done prudently."

Patients in the stent group were significantly less likely to have a prolonged hospital stay (odds ratio, 0.50) and more likely to be discharged to home (OR, 0.14). They tended to have similar or fewer complications than patients in the stoma group. The odds ratio for major events was 0.81 and for procedural complications, it was 0.57.

There was no significant difference in 90-day or one-year hospital readmissions. This was also the case for subsequent operations at 90 days.

There was, however, a higher chance of subsequent operation at one year after stenting procedure (OR, 2.93). Most of these subsequent operations were restenting, which the investigators say is "still less invasive than exploratory laparotomy or stoma creation."

Overall the researchers conclude that "if resection is not part of the treatment plan, stenting is safe and improves the efficiency of care with obvious quality-of-life benefits. It should be offered at experienced centers, and patients should be counseled regarding increased risk of subsequent stenting within one year."

Commenting by email, Dr. Tim Eglinton of the University of Otago, Christchurch, New Zealand, told Reuters Health, "The main downside of colonic stents is the potential for reobstruction which is however dealt with simply by restenting."

Dr. Eglinton, who is Consultant Colorectal and General Surgeon, said the study "provides further evidence that for many patients colonic stenting, performed by endoscopists experienced in the technique, is the best option for palliation of malignant bowel obstruction."

SOURCE: http://bit.ly/2jLaPVG

JAMA Surg 2017.