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Endoscopy 2008; 40(3): 184-191
DOI: 10.1055/s-2007-995426
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer

J.  E.  van Hooft1 , P.  Fockens1 , A.  W.  Marinelli2 , R.  Timmer3 , A.  M.  van Berkel4 , P.  M.  Bossuyt5 , W.  A.  Bemelman6 , on behalf of the Dutch Colorectal Stent Group[1]
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 2Department of Surgery, Medical Center Haaglanden, Den Haag, The Netherlands
  • 3Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
  • 4Department of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, The Netherlands
  • 5Department of Clinical Epidemiology and Bio-statistics, Academic Medical Center, Amsterdam, The Netherlands
  • 6Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
Further Information

Publication History

submitted 11 September 2007

accepted after revision 24 October 2007

Publication Date:
06 March 2008 (online)

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Commentaire de travail de J. E. van Hooft et al., pp. 184Endoscopy 2008; 40(03): 355-355
DOI: 10.1055/s-0032-1306813

Background and study aims: The introduction of self-expandable metal stents has offered a promising alternative for palliation of malignant left-sided colonic obstruction. This randomized clinical trial aimed to assess whether a nonsurgical policy, with endoluminal stenting, is superior to surgical treatment in patients with stage IV left-sided colorectal cancer and imminent obstruction.Patients and methods: Patients with incurable left-sided colorectal cancer who fulfilled the study criteria were randomly assigned to nonsurgical or surgical treatment. The primary outcome measure was survival in good health out of hospital (World Health Organization performance scores 0 or 1).Results: A high number of serious adverse events in the nonsurgical arm led to premature closure of the trial. Ten patients were allocated to surgical treatment and 11 patients to nonsurgical palliation. The median survival in good health out of hospital during the first year was 56 days (interquartile range 7.5 - 338.5 days) in the surgical arm vs. 38 days (interquartile range 5.25 - 288.75 days) in the nonsurgical arm (P = 0.68). Eleven adverse events (six perforations) occurred in the nonsurgical arm vs. one adverse event in the surgical arm (P < 0.001). Of the six perforations, two were stent-related because they occurred at the proximal edge of the stent by erosion through a normal colon wall; one was probably stent-related (it was located in the region of the proximal half of the stent); one was a colon blowout; and two were late tumor perforations in patients on chemotherapy.Conclusions: The unexpected high rate of perforation in the nonsurgical arm might be specifically WallFlex-related or enteral stent-related in patients on chemotherapy and warrants attention.

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1 See Appendix

W. A. Bemelman, MD, PhD 

Academic Medical Center
Department of Surgery

Meibergdreef 9
1105 AZ Amsterdam
The Netherlands

Fax: +31-206914858

Email: W.A.Bemelman@amc.nl

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