Pre-Surgery Technique May Make Colostomy Bags Redundant

Endoluminal stenting to unblock the bowel before surgery could lead to fewer emergency bowel cancer patients needing a colostomy bag, according to a new study.

Researchers at the Manchester Royal Infirmary (MRI, United Kingdom), the University of Oxford (United Kingdom), and other institutions conducted a study involving 246 patients presenting in the emergency setting with left-sided colonic obstruction needing urgent decompression, and radiological features of a carcinoma. Patients were randomized to endoluminal stenting as a bridge to elective surgery performed 1-4 weeks later, or to surgical decompression.

The results showed that 30-day post-operative mortality and length of hospital stay were similar with stenting and surgery. But while 69% of the emergency surgical decompression patients needed a colostomy bag, only 45% of the endoluminal stenting as a bridge to surgery needed one. Stenting also achieved relief of obstruction in 82% of patients and reduced stoma formation; there were no significant differences in one-year mortality between groups. The study was presented at the American Society of Clinical Oncology (ASCO) cancer conference, held during June 2016 in Chicago (IL, USA).

“Traditionally, doctors have worried that unblocking the bowel in this way could increase the chance of cancer spreading, but our early results don’t show this. We’re also pleased to see that this could be a way of reducing the risk of patients needing a colostomy bag after their surgery, which is a huge improvement to patients’ day-to-day lives,” said lead author Professor James Hill, of the MRI. “These are early results, and we’ll need to follow-up our work for three years in full to find out if this technique affects survival and end-of-life care for bowel cancer patients.”

“This treatment isn’t suitable for everyone, but for those who are it could have a huge impact on their lives after surgery. Not needing a colostomy bag is likely to significantly improve the quality of life of patients,” added Martin Ledwick, head information nurse of Cancer Research UK (London). “If longer term follow-up and larger studies confirm these results, it is great news for bowel cancer patients who come to A&E with bowel blockages.”

A colostomy is an artificial opening (stoma) created surgically in the large intestine that allows the removal of feces out of the body, bypassing the rectum, to drain into a removable pouching system (the colostomy bag) that collects and contains the output for later disposal.

Related Links:
Manchester Royal Infirmary
University of Oxford
Cancer Research UK