Improving Quality of Life for People with Incurable Large-Bowel Obstruction. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Young, Christopher J.; De-loyde, Katie J.; Young, Jane M.; Solomon, Michael J.; Chew, Emily H.; Byrne, Chris M.; Salkeld, Glenn; Faragher, Ian G.
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 9(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000431
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>Surgery remains the dominant treatment for large-bowel obstruction, with emerging data on self-expanding metallic stents.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The aim of this study was to assess whether stent insertion improves quality of life and survival in comparison with surgical decompression.</p> </sec> <sec> <title>DESIGN:</title> <p>This study reports on a randomized control trial (registry number ACTRN012606000199516).</p> </sec> <sec> <title>SETTING:</title> <p>This study was conducted at Royal Prince Alfred Hospital, Sydney, and Western Hospital, Melbourne.</p> </sec> <sec> <title>PATIENTS AND INTERVENTION:</title> <p>Patients with malignant incurable large-bowel obstruction were randomly assigned to surgical decompression or stent insertion.</p> </sec> <sec> <title>MAIN OUTCOME MEASURES:</title> <p>The primary end point was differences in EuroQOL EQ-5D quality of life. Secondary end points included overall survival, 30-day mortality, stoma rates, postoperative recovery, complications, and readmissions.</p> </sec> <sec> <title>RESULTS:</title> <p>Fifty-two patients of 58 needed to reach the calculated sample size were evaluated. Stent insertion was successful in 19 of 26 (73%) patients. The remaining 7 patients required a stoma compared with 24 of 26 (92%) surgery group patients (<italic>p</italic> < 0.001). There were no stent-related perforations or deaths. The surgery group had significantly reduced quality of life compared with the stent group from baseline to 1 and 2 weeks (<italic>p</italic> = 0.001 and <italic>p</italic> = 0.012), and from baseline to 12 months (<italic>p</italic> = 0.01) in favor of the stent group, whereas both reported reduced quality of life. The stent group had an 8% 30-day mortality compared with 15% for the surgery group (<italic>p</italic> = 0.668). Median survival was 5.2 and 5.5 months for the groups (<italic>p</italic> = 0.613). The stent group had significantly reduced procedure time (<italic>p</italic> = 0.014), postprocedure stay (<italic>p</italic> = 0.027), days nothing by mouth (<italic>p</italic> = 0.002), and days before free access to solids (<italic>p</italic> = 0.022).</p> </sec> <sec> <title>LIMITATIONS:</title> <p>This study was limited by the lack of an EQ-5D Australian-based population set.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>Stent use in patients with incurable large-bowel obstruction has a number of advantages with faster return to diet, decreased stoma rates, reduced postprocedure stay, and some quality-of-life benefits.</p> </sec> </abstract>