TY - JOUR
T1 - Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer
T2 - randomized clinical trial
AU - CReST Collaborative Group
AU - Hill, James
AU - Lee, S.
AU - Morton, D.
AU - Parker, M.
AU - Halligan, S.
AU - Taylor, S.
AU - Kay, C.
AU - Gray, R.
AU - Handley, K.
AU - Kaur, M.
AU - Magill, L.
AU - Fulcher, L.
AU - Lilly, H.
AU - Palmer, A.
AU - Peters, A.
AU - Sidile, C.
AU - Wilcockson, A.
AU - Bensoussane, H.
AU - Marchevsky, N.
AU - Oliver, A.
AU - Carlson, G.
AU - Scott, N.
AU - Hiller, L.
AU - Alderson, D.
AU - Martin, D.
AU - Yu, L.
AU - Chokkalingam, A.
AU - Cross, N.
AU - Delicata, R. J.
AU - Edwards, P.
AU - Sturgeon, G.
AU - Domingo, D.
AU - Gutmann, J.
AU - Huang, J.
AU - Mills-Baldock, T.
AU - Mtwana, A.
AU - Premchand, P.
AU - Willis, N.
AU - Cocks, S.
AU - Curran, E.
AU - Gall, Z.
AU - Harris, P.
AU - Hobbiss, J.
AU - Lipscomb, G.
AU - Maxwell, A.
AU - Patel, H.
AU - Smith, D.
AU - Antrum, R. M.
AU - Beckett, C. G.
AU - Bach, S.
N1 - Funding Information:
The CReST trial was funded by Cancer Research UK (C25359/ A8975). The study funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors had full access to all data in the study and had final responsibility for the decision to submit for publication.
Publisher Copyright:
© The Author(s) 2022.
PY - 2022/11
Y1 - 2022/11
N2 - 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).
AB - 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).
UR - http://www.scopus.com/inward/record.url?scp=85140144608&partnerID=8YFLogxK
U2 - 10.1093/bjs/znac141
DO - 10.1093/bjs/znac141
M3 - Article
C2 - 35986684
AN - SCOPUS:85140144608
SN - 0007-1323
VL - 109
SP - 1073
EP - 1080
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 11
ER -