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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: Randomized clinical trial
British Journal of Surgery, Volume 109, No. 11, Year 2022
Notification
URL copied to clipboard!
Description
Background: Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. Methods: Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1-4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. Results: Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P=0.48), or duration of hospital stay (median 19 (i.q.r. 11-34) versus 18 (10-28) days; P=0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P=0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. Conclusion: Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com). © The Author(s) 2022.
Authors & Co-Authors
Morton, Dion G.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Halligan, Steve M.
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
Magill, Laura
United Kingdom, Birmingham
University of Birmingham
Fulcher, Leanne
United Kingdom, Birmingham
University of Birmingham
Palmer, Andrew J.
United Kingdom, Birmingham
University of Birmingham
Marchevsky, Natalie G.
United Kingdom, Birmingham
University of Birmingham
Hiller, Louise
United Kingdom, Coventry
University of Warwick
Alderson, Derek A.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Davies, James E.
United Kingdom, Bradford
Bradford Teaching Hospitals Nhs Foundation Trust
United Kingdom, Cambridge
Cambridge University Hospitals Nhs Foundation Trust
Jowett, Sue M.
United Kingdom, Bradford
Bradford Teaching Hospitals Nhs Foundation Trust
Brown, Helen K.
United Kingdom, Cambridge
Cambridge University Hospitals Nhs Foundation Trust
Fearnhead, Nicola S.
United Kingdom, Cambridge
Cambridge University Hospitals Nhs Foundation Trust
Fuller, Barry J.
Unknown Affiliation
Walsh, Kevin P.
United Kingdom, Reading
Royal Berkshire Nhs Foundation Trust
Bird, Nigel Charles
United Kingdom, Tyne and Wear
Gateshead Health Nhs Foundation Trust
Chung-Faye, Guy A.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Leather, Andrew J.M.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Papagrigoriadis, Sav S.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Peddu, Praveen
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Everett, Simon M.
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Griffiths, Ben
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Hussain, Margub
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Moriarty, Catherine
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Priestley, Mark
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
White, Louise
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Thomas-Gibson, Siwan
United Kingdom, Harrow
London North West University Healthcare Nhs Trust
Kirk, Stephen James
United Kingdom, Manchester
Manchester University Nhs Foundation Trust
Narula, Harjeet Singh
United Kingdom, Wakefield
The Mid Yorkshire Hospitals Nhs Trust
Horgan, Philip
United Kingdom, Glasgow
Nhs Greater Glasgow and Clyde
Watson, Angus J.M.
United Kingdom, Inverness
Nhs Highland
Agarwal, Anil Kumar
United Kingdom, Stockton on Tees
North Tees and Hartlepool Nhs Foundation Trust
Borowski, David W.
United Kingdom, Stockton on Tees
North Tees and Hartlepool Nhs Foundation Trust
Garg, Dharmendra K.
United Kingdom, Stockton on Tees
North Tees and Hartlepool Nhs Foundation Trust
Gill, Talvinder Singh
United Kingdom, Stockton on Tees
North Tees and Hartlepool Nhs Foundation Trust
Wilson, Deborah A.
United Kingdom, Stockton on Tees
North Tees and Hartlepool Nhs Foundation Trust
Taylor, Jenna Leigh
Unknown Affiliation
Scholefield, John Howard
United Kingdom, Nottingham
Nottingham University Hospitals Nhs Trust
Cunningham, Christopher W.
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Mortensen, Neil J.Mc C.
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Gibson, Michael K.
United Kingdom, Reading
Royal Berkshire Nhs Foundation Trust
Jones, Laura L.
United Kingdom, Reading
Royal Berkshire Nhs Foundation Trust
Lees, Nicholas P.
United Kingdom, Salford
Salford Royal Nhs Foundation Trust
Thompson, Chris Vaun
United Kingdom, Salford
Salford Royal Nhs Foundation Trust
Brown, Steven Ross
United Kingdom, Sheffield
Sheffield Teaching Hospitals Nhs Foundation Trust
Tham, Tony C.K.
United Kingdom, Dundonald
South Eastern Health and Social Care Trust
Shepherd, Edward G.
United Kingdom, Plymouth
University Hospitals Plymouth Nhs Trust
Richards, Dawn P.
Unknown Affiliation
Forde, Colm
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Tucker, Olga N.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Vohra, Ravinder S.
United Kingdom, Birmingham
University Hospitals Birmingham Nhs Foundation Trust
Reynolds, Jenifer R.
United Kingdom, Derby
University Hospitals of Derby and Burton Nhs Foundation Trust
Russell, Anne Marie
United Kingdom, Yeovil
Yeovil District Hospital Nhs Foundation Trust
Nunn, Andrew J.
United Kingdom, York
York Teaching Hospital Nhs Foundation Trust
Statistics
Citations: 8
Authors: 53
Affiliations: 46
Identifiers
Doi:
10.1093/bjs/znac141
ISSN:
00071323
Research Areas
Cancer
Disability
Health System And Policy
Study Design
Randomised Control Trial