Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial

著者: CReST Collaborative Group, James Hill, S Lee, Dion Morton, M. C. Parker, Steve Halligan, Stuart A. Taylor, C Kay, Richard Gray, K Handley, Manjinder Kaur, Laura Magill, Letitia C. Fulcher, Manjinder Kaur, Helen Lilly, Alan Warwick Palmer, Amelia A. Peters, Laura Magill, Chakanaka Sidile, Adrian Wilcockson, Hannah Bensoussane, K Handley, Natalie G. Marchevsky, Alfred Oliver, G Carlson, Nigel Scott, Louise Hiller, Derek Alderson, Derrick Martin, Ly‐Mee Yu, Arun Chokkalingam, Nicholas Cross, Ray Delicata, Phil Edwards, Gregory M. Sturgeon, D. Domingo, James L. Gutmann, Jinfeng Huang, Tina Mills‐Baldock, A Mtwana, Purushothaman Premchand, Nicola Willis, S Cocks, E Curran, Zara Gall, Pastor C. Harris, J Hobbiss, George Lipscomb, A Maxwell, Heena Patel, David C. Smith, R M Antrum, Conrad Beckett, Justine Davies, Tapas Ghosh, Jay Gokhale, J Griffith, J Halstead, Christian Jackson, Sue Jowett, C Kay, A Lowe, James W. May, Joan McGowan, J. Robinson, R Simpson, Sophie Stephenson, Mark Steward, Brittany Thomas, Austin D. Thrower, Karen Ward, Jason Dexter, Tracy J. Doyle, P A Farrands, Amy C. Hart, Marc Lamah, J Peterson, Hannah Brown, E. Cameron, N Carroll, Justine Davies, Nicola Fearnhead, K. Goodwin, Alexander D. Liddle, Rachel W. Miller, J R Morton, Michael Powar, Deborah Read, Kirsten Sloan, J Uttridge, J Wheeler, Iain Bain, S. K. Clark, Jeremy Cundall, John Dent, Susan Green, N.D. Grunshaw, K. Gunning, A. E. Howey, Sarah Marsden, I. Minty, Laura C Morgan, Sophie Noblett, Kyle Potts, John Scott, Deborah Turnbull, J S Varma, Laura L. Wayman, Sarah J. Welsh, Amy S. Anstead, Rakesh Bhardwaj, T Edmunds, Barry Fuller, Phyllis Holder, Linda Lacey, M. C. Parker, Ronan Ryan, J Smith-Hedges, C Stuart, Katherine Walsh, Abhimanyu Basu, Abdul Rahman Omar, J Pitt, Graham Read, Paul Ridley, John H. Spurgeon, Yvonne Tricker, N. Bird, David Browell, C Barry, W.J. Cunliffe, M Eltringham, M Katrory, Mark Mercer‐Jones, Colin Nice, John Scott, Grace Timmons, M Williams, C Wipat, James D. Akula, Abby Caine, Pamela Dawson, Gerhard Reese, Y Fatola, B. Mazibuko, Mary Pelling, L Ramos, Geoff Smith, Kamal Aryal, Khaleel K. Ashraf, Rawya Badreldin, B Brett, A DeSilva, Stuart R. Gray, John Harman, M Jordon, K Kshatriya, Roshan Lal, Luke A. Perry, Vamsi Velchuru, M Williams, G Chung-Faye, Anika Hansmann, Andrew Leather, Savvas Papagrigoriadis, Praveen Peddu, Sara Ryan, Samuel S. Ambrose, Ross Baker, D Beral, I. D. Botterill, Dermot Burke, L. Clarke, Martin Evans, Simon Everett, P J Finan, B Griffiths, J Hamlin, Julian Hance, Kelly T. Harris, Mohamad A. Hussain, David Jayne, Sean G. Kelly, Michael Lim, S. Maslekar, Danilo Mišković, C Moriarty, M Priestley, S Rawson, Pallavi Sagar, R. N. Saunders, Maria Sheridan, Holly Speight, Damian Tolan, Leah White, Lawrence H. Wilkinson, Tim Wilson, D Burling, S. K. Clark, Pooja Datt, Chris Fraser, Ashish Gupta, Ian Jenkins, Robin H. Kennedy, John Northover, Samia Sakuma, BP Saunders, Noriko Suzuki, Siwan Thomas‐Gibson, Finlay Curran, Debbie Hitchen, Arul Immanuel, Stephen Kirk, RS Kushwaha, S Lee, M. C. Parker, Angélica Vanessa, Jenny Butler-Barnes, Colleen D. Hough, A. Khan, Tracy Larcombe, I London, Chelliah Selvasekar, S Zaman, James C. Anderson, Julie Ball, M Basheer, Julie Brittenden, Adeshina Fawole, Roger S. Foster, Kathryn Gill, A Hayton-Bott, Anna‐Marie Jones, Konstantinos Kamposioras, Stephen J. Kerr, T. F. Lowry, S.C. Lupton, Charles Macklin, Carl Morrison, Charles Morrison, Himanshu Narula, Catherine Parchment-Smith, Mary A.M. Rogers, Saloni Shah, Rangasamy Sivakumar, N. Sivaramakrishnan, Deven Vani, Karan Verma, C Sivanathan, Peter Chong, M. J. Duff, Katherine Duffey, Paul G. Horgan, Lesley McGregor, Ruth F. McKee, John R. Pender, S. Viswanathan, Margaret Ashcroft, James C. Docherty, Abbie Donaldson, Michael Lim, K Macleod, A. MacLeod, AC Todd, Kenneth Walker, Angus Watson, Hl Younger, John E. Brush, Stephen Glancy, M MacRury, J Mander, Hugh Paterson, Leanne Atkin, Caroline Brain, Sarah Brunt, C A V Burt, Helen Cheshire, Madeleine Clout, Helen Corderoy, Clyde J. Dawe, Angel Dixon, H Garlicka, Marina Hopes, S.K.P. John, Kim Kirby, S Kirkpatrick, R. M. Law, A.J. Longstaff, Eric Loveday, Alan M. Lyons, Katie McCarthy, Anne Pullyblank, Aoife Reilly, Kerry Richmond-Russell, A M Roe, Leyana R. Saville, L Shelton, N.H. Slack, Craig Smith, L Solomon, A Treasure, Anil Agarwal, David W Borowski, A Chilvers, D Dwarakanath, Spencer Essex, D Garg, Talvinder Gill, Elisabeth Jameson, Paul Jones-King, S Kiddell, Hadri Latif, Joanne Latimer, Lois E. Shepherd, S Sinclair, Mohamed Tabaqchali, Hayley Wardle, David Wilson, Adnan Ahmad, Abdul Arain, Mark Cartmell, Kate Cross, Aileen M. Davis, J Groome, B Holbrook, S. C. Ley, N. Markham, Mahesh Menon, John Taylor, Frank Thomas, Lynne van Koutrik, Seraj Ahmad, V Cursley, Karin M. Dent, Karen Martin, Dinker Pai, Sarah Pearson, J F Abercrombie, Austin G. Acheson, Lewis Aldred, N C Armitage, Ayan Banerjea, Chris Coulson, Michael Eyre, Charles Maxwell‐Armstrong, RICHARD F. O'NEIL, Krish Ragunath, M.H. Robinson, J H Scholefield, Richard Swinden, John P. Williams, S. Anthony, Mark Bratby, C Cunningham, S Fourie, Oliver Jones, Ian Lindsey, F Morrison, N. J. Mortensen, D Munday, Raman Uberoi, F Ahmad, Nemi Chandra J, Philip G. Conaghan, D. B. Coull, Julie Foxton, Michelle Gibson, W Hameed, Louise Jones, D McGrath, James R. Ramus, T Samakomva, Archie Speirs, Katherine Walsh, H Arumugam, A Ewiddison, W Faux, Mark Feldman, Sivakumar Gopalswamy, Lee Graves, J Hancock, Philip Harvey, Haizal Mohd Hussaini, Edward Lloyd-Davies, C.R. Lynn, Jillian Madine, Giles Maskell, Nicholas Morley, Katherine S. Pollard, Keith Prout, P. Boorman, Brian P. Dickinson, Richard Guinness, Taylor Hill, Jonathan Moran, I D Anderson, Anita Ashton, Charles F. Babbs, Hal A. Burnett, Kay Goulden, Patricia Harrison, Luc Härter, Steven J. Hughes, Victoria Kenyon, S Lee, Nicholas P. Lees, Anna Lydon, Angela Ogden, L Ottiwell, Daci Platt, Frances Read, Dominic Slade, Paul M. Thompson, Cellins Vinod, David Watson, Sarah Brown, Deirdre Donnelly, J Hampton, I A Eyre-Brook, Jayne Foot, Nicholas R. Forsyth, Louise Hunt, A Lowe, P Mackey, Rudi Matull, Huw Thomas, Christopher Vickery, Grant R. Caddy, J Foreman, Michael E. Hyland, K McCallion, E McFerran, Tony Tham, J R A Turkington, Simon Day, James Francombe, P. Murphy, E. Simmons, Rajeev Sinha, David M. Bull, A Compson, Milena Gould, Sauid Ishaq, Anthony Kawesha, Kataneh Maleki, Mark Marriott, L Poutney, Paul Stonelake, Claire Adams, Simeon Brundell, M Coleman, H. M. Congdon, Walter Douie, Leonie Eastlake, Louise Evenden, Benjamin Fox, C Gandy, Konstantinos Georgiadis, Ken B. Hosie, Andrew Latchford, F C Oppong, Jennifer Pascoe, Mariela Rance, Ewen Shepherd, John P. Shirley, H Smith, Barry Appleton, C Bobary, Mark Feeney, Aaron Gardner, F F Krouma, David M. Richards, L Roche, Gail Tudor, Tai‐Horng Young, A Olufunso, Derek Alderson, Muhammad Atif, Simon P. Bach, J Dasgin, Colm Forde, Kaori Futaba, Manijeh Ghods-Ghorbani, David Gourevitch, Tariq Ismail, Christopher Hang Liang Keh, N Manimaran, Ian McCafferty, Dion Morton, Steve Pandey, Stephen Radley, Peter Riley, J Royle, Nigel Suggett, Andrew Torrance, Olga Tucker, Ravinder Vohra, Jessica Aldous, D Beal, H Beveridge, Sonya Bradshaw, Alison Carrick, Chris Coulson, Julie Dockree, Mary C. Fearon, Adrian Hall, Kathleen Holding, N P Hurst, GB Irvine, Kyle M Langston, Jonathan N. Lund, Gemma Redfern, David Reeves, J. R. Reynolds, Jennifer K. Rowntree, Kent P. Simmonds, Rajeev Singh, W. J. Speake, Gillian Tierney, Samson Tou, C Worth, B Singh, Raman Verma, J Allison, Andrew Allison, N C Bathurst, C Buckley, James Gotto, Z. U. Khan, Jonathan Ockrim, R Rowland-Axe, Ann Russell, Katie Spurdle, Barbara Williams-Yesson, A. Ames, P C Rylance, S Dyer, Jeffrey J. Fletcher, Samuel Kent, N W Law, J MacFie, K. S. Mainprize, Joanne Mallinson, Carmel McNaught, Catherine Mitchell, Andrew Nunn, Ian Renwick - British journal of surgery 2022 被引用: 79

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).