Trial Information

Endolaparoscopic Versus Immediate Surgery for Obstructing Colorectal Cancers: A Randomised Trial

In patients who present with obstructing left-sided colorectal cancers, emergency surgery
carries a significant morbidity and mortality. Traditionally, most of these patients would
receive staged operations (Hartmann's procedure). Temporary stoma is often required due to
the edematous bowel wall precluding primary anastomosis as a result of obstruction and the
poor pre-morbid status. A second operation is subsequently required to restore bowel
continuity. Apart from the expensive hospital costs of the staged operations, the patient's
acceptance to the stoma is poor and the social inconvenience associated with the stoma is
obvious. Thus, a significant portion of patients would not be suitable for the second
operation due to poor health or advanced disease and having to bear the stoma for the
remainder of life. Recently, self-expandable metal stents have been used with success in
relieving the acute obstruction in patients with obstructing left-sided colorectal cancers.
Endoscopic stenting may help to relieve the obstruction, avoid emergency surgery, and allows
patients to undergo one-stage elective surgery without the necessity of making a stoma. We
propose to evaluate the clinical benefits of using self-expandable metal stents in patients
with obstructing left-sided colorectal cancers followed by elective laparoscopic resection
and compare its use to immediate emergency surgery.