Outcomes of colorectal stents when used as a bridge to curative resection in obstruction secondary to colorectal cancer

Philip R Harvey,Prashant Patel,Felicity Evison,Hina Waheed,James Rees,Simon Baldwin,Nigel J Trudgill,Jamie-Rae Tanner

doi:10.1007/s00384-019-03302-5

Abstract

BackgroundUp to 25% of colorectal cancers present with bowel obstruction. Metal stents (MS) can provide a bridge to surgery by relieving obstruction and allowing the subject’s condition to improve pre-operatively.MethodsHospital Episode Statistics (HES) is a database of all NHS funded secondary care episodes in England. Subjects admitted with bowel obstruction secondary to colorectal cancer without metastases were identified and subdivided into two groups: MS insertion prior to surgery and surgery only. Due to demographic differences between the groups, propensity score matching was used to analyse procedural outcomes, mortality and readmission within 30 days in left-sided cancers based upon age, sex and Charlson co-morbidity score.ResultsOver 10 years, 4571 subjects were identified; 401 received a MS and 4170 underwent surgery only. Median age of MS subjects was 71 (IQR 62–79) years; 226 (56.4%) were male. Median age of surgery-only subjects was 73 (64–81); 2165 (51.9%) were male. Following propensity matching 375 MS and 375 surgery-only subjects remained; MS had fewer readmissions within 30 days (28 (7.5%) versus 44 (11.7%), p = 0.047), fewer respiratory complications (< 6 (< 1.5%) versus 28 (7.5%), p < 0.001), lower stoma rates (49 (13.1%) versus 159 (42.4%), p < 0.001) and higher rates of laparoscopic surgery (154 (41.1%) versus 25 (6.7%), p < 0.001). Mortality was lower in the MS group at 30 days (7 (1.9%) versus 33 (8.8%), p < 0.001) and 1 year (37 (9.9%) versus 71 (19.0%), p < 0.001).ConclusionsIn subjects presenting with obstructing colorectal cancer outcomes including respiratory complications, readmission and mortality appear to be better in subjects undergoing MS as a bridge to surgery compared to surgery alone.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Colorectal cancer is the third most common form of cancer internationally [1]
Between 2012 and the end of 2014 at Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, 27 Metal stents (MS) were inserted for obstruction secondary to cancer
The CREST study, currently published in abstract form only, provides further opportunity for validation [9]

Summary

Introduction

The primary treatment goal is to relieve the obstruction, usually through emergency surgery Such operations carry significant risks, and recently published outcome data suggest that in-hospital mortality is as high as 14% [4]. Subjects admitted with bowel obstruction secondary to colorectal cancer without metastases were identified and subdivided into two groups: MS insertion prior to surgery and surgery only. Due to demographic differences between the groups, propensity score matching was used to analyse procedural outcomes, mortality and readmission within 30 days in left-sided cancers based upon age, sex and Charlson co-morbidity score. Conclusions In subjects presenting with obstructing colorectal cancer outcomes including respiratory complications, readmission and mortality appear to be better in subjects undergoing MS as a bridge to surgery compared to surgery alone

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