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Session: ePoster: Colon and Colorectal Cancer 13 (Mon1015)

EP705 - Endoscopic stenting for patients presenting acutely with obstructing left-sided colorectal cancer: a secondary analysis of the APOLLO study

Monday, May 12, 2025
10:36 AM – 10:41 AM PT

    Author(s)

  • Chris Varghese, MBChB, BMedSc(Hons)

    Junior Doctor and PhD Candidate
    University of Auckland
    Auckland, Auckland, New Zealand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Senior Author(s)

  • EC

    EuroSurg Collaborative, MBChB

    Student- and Trainee Research Collaborative
    EuroSurg Collaborative
    Auckland, Auckland, New Zealand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • ePoster Presenter(s)

  • Judy Suh, Medical Student

    Student
    University of Illinois at Chicago College of Medicine - Peoria

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Chris Varghese, MBChB, BMedSc(Hons): This individual has no relevant relationships with ineligible companies.
EuroSurg Collaborative, MBChB: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Endoscopic colonic stenting is a potentially lifesaving alternative to surgical decompression in patients presenting acutely with obstructing colorectal cancer. Randomised evidence suggests endoscopic stenting may be a feasible bridge to surgery, yet is not widely used due to concerns of complications and oncological outcomes. Little is known about the global use and outcomes after endoscopic stenting.

Methods/Interventions: Acute PresentatiOn of coLorectaL cancer - an internatiOnal snapshot (APOLLO) was a prospective cohort study which enrolled consecutive adults presenting acutely with colorectal cancer between January and June 2023. In this planned secondary analysis, propensity score matching was performed between patients that were stented versus received index surgery. The primary outcome was 90-day mortality, and the secondary outcomes included 90-day unplanned readmission, and days alive and out of hospital at 90 days (DAOH-90).

Results/Outcomes: 516 patients presented acutely with obstructing left-sided colon cancer (179 centres, 37 countries; median age 69 years; 56% female; median clinical frailty score 3.0) of which 47 (9.1%) were managed nonoperatively, 54 (10.5%) were endoscopically stented, and 415 (80.4%) received an operation. Stenting was predominantly performed in high income countries (94.4%; Figure 1) and stented patients more frequently had metastatic disease (46% vs 26%, p< 0.001). Of those that were stented, 11 (20.4%) received elective surgery within 90-days and 5 (9.3%) had stent related complications (2 migrations, 2 obstructions, 1 perforation). After multivariable adjustment, stenting was associated with a similar odds of mortality (OR 0.75, 95% CI 0.3 - 2.09, p = 0.6), unplanned readmission (OR 1.18, 95% CI 0.29 - 5.80, p = 0.8), and days alive and out of hospital (adjusted mean 65.2 vs 65.3 days, p=0.98) within 90-days.

Conclusion/Discussion: Endoscopic stenting was associated with comparable morbidity and mortality to surgical decompression in the acute setting and represents a feasible index management option for patients presenting with left-sided obstructing colorectal cancer.