How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction

Surgery
Michael K L SuenChristopher J Young

Abstract

Colorectal stents have been available as a management option in obstruction for 23 years, yet there is little randomized evidence of their effectiveness. This study investigated current surgeon-related barriers to conducting a randomized, controlled trial (RCT) of colorectal stent insertion for obstruction in patients with colorectal cancer. A binational survey of current members of the Colorectal Surgical Society of Australia and New Zealand was conducted by a mailed questionnaire assessing perceived barriers to adoption of colonic stents and willingness to participate in future multicentre randomized controlled trials, and surgeons' treatment preferences in 16 hypothetical clinical scenarios. Of 148 eligible surgeons, 96 (65%) responded. Colonic stenting was available to 98% of respondents. In the clinical setting of colorectal obstruction, only 29% (95% CI, 20-39%) of surgeons expressed a willingness to participate in a RCT involving colonic stents in the curative setting. More than 70% of surgeons preferred the use of stents in unfit patients for palliation, and preferred surgery in fit patients with curable disease. In the curative setting, most respondents considered colonic stents not cost effective (90%; 95% CI, 82-94%)...Continue Reading

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Citations

Jun 13, 2017·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A ManganoR W Motson
Feb 5, 2016·World Journal of Gastrointestinal Surgery·Assad Zahid, Christopher John Young
May 20, 2020·Annals of Coloproctology·Auerilius Erastus Ricardo HamiltonChristopher John Young
Jun 9, 2019·International Journal of Colorectal Disease·Philip R HarveyNigel J Trudgill

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