PTU-044 To stent or not to stent in malignant large bowel obstruction

Introduction Self expanding metallic stents (SEMS) can resolve obstruction due to colorectal cancer (CRC), enabling subsequent elective rather than emergency surgery. This study compared the outcomes after stenting and subsequent elective surgery versus emergency surgery (ES) for obstructing CRC. Methods Prospectively collected data from a consecutive series of 153 patients with large bowel obstruction secondary to CRC, presenting to a single NHS Trust from April 2010 to March 2017, were retrospectively analysed. Of these, 41 (26.8%) had stenting as a bridge to surgery (SBTS) followed by elective surgery and 112 (73.2%) had ES. Primary outcomes were mortality rates after surgery at 30 days, 90 days and 1 year. Secondary outcomes were the rates of stoma formation and anastomotic leak (both clinical and radiological). Results Thirty-day mortality was 7.3% with SBTS and 12.5% with ES. Ninety-day mortality was 7.3% with SBTS and 17.9% with ES. One-year mortality was 19.5% with SBTS and 32.1% with ES. The anastomotic leak rate was 7.1% with SBTS and 14.0% with ES. The rate of stoma formation was 39.0% with SBTS and 33.0% with ES. With cancers proximal to the splenic flexure excluded, stoma rates were 38.5% with SBTS and 54.2% with ES. Conclusions Without adjustment for confounding variables superiority of SBTS over ES cannot be inferred. But these results suggest SBTS can be a safe alternative to ES and may offer advantages in respect of stoma and leak rates.