Grant: CAG/CIHR Fellowship for Research in Gastroenterology/Nutrition

It is estimated that up to 29% of patients with advanced colorectal cancer will present with bowel obstruction. Treatment involves either surgery or insertion of metal stents to resolve the obstruction. Published studies have shown that metal stents are effective in relieving colon cancer obstruction; however, a limitation of current research is that the vast majority of published trials are small, study only a narrow patient population, and only follow patients for a short period of time. Currently, there is little known on how clinicians are using these stents in real world clinical practice (outside of the controlled setting of a clinical trial), and the outcomes over several years in patients who receive these stents. This is an important question because the results of clinical trials can differ when applied to routine clinical practice; where patients are heterogeneous and unpredictable, follow-up is longer, and unexpected or unknown factors arise. Using data from linked administrative health databases, our research project will address two aims. The first to describe the demographic, clinical, geographic, and temporal characteristics of colonic stent use for colorectal cancer obstruction in the province of Ontario, Canada. The second is to report the clinical course after colonic stent insertion in these patients, including adverse events. Predictors of adverse events will also be identified. The analysis will provide insight into the current practice of colorectal stent insertion for malignant bowel obstruction in Ontario, Canada. This research can improve the care of patients with bowel obstruction from colorectal cancer. Determining the patterns of use, and associated short and long-term clinical course in a large population-based cohort will allow clinicians to better advise patients on expected outcomes after stent insertion, and may demonstrate which patients benefit most after colorectal stent insertion.