Role of endoluminal stenting in the acute management of obstructing colorectal cancer trial (CReST)

Welcome to the CReST Trial Website.

CReST is currently open to recruitment!


 

CReST is a multicentre randomised controlled trial designed to provide reliable evidence on the value of stenting compared to standard surgical techniques in obstructing colorectal cancer.

 

Trial Rational

Colorectal cancer is the second most common malignant disease in developed countries, with about a million new cases and 500,000 deaths worldwide each year. Up to 30% of colorectal cancers present as an emergency with large bowel obstruction. Emergency surgery for obstructing colorectal cancer is associated with high morbidity and mortality, prolonged hospital stay and a high frequency of stoma formation, compromising the patient's quality of life. Patients treated in the emergency setting are also compromised in their subsequent care, notably because they are frequently unable to tolerate adjuvant chemotherapy.

Stenting of large bowel obstructions provides the potential to avoid emergency surgery, allow full assessment and preparation of the patient for surgery, with the potential to reduce operative morbidity and improve quality of life and survival. However, stenting can sometimes perforate the bowel wall and may increase the risk of tumour dissemination. The balance of benefits and risks has not yet been reliably assessed. CReST (ColoRectal Stenting Trial)  is a randomised controlled trial to investigate whether endoluminal colonic stenting for obstructing colorectal cancer will result in reduced operative morbidity, reduced length of hospital stay, a reduced rate of stoma formation and improved quality of life and survival compared to conventional treatment.

Trial Design

Patients presenting in the emergency setting with left-sided colonic obstruction and radiological features consistent with a carcinoma who are considered to require urgent decompression are randomised to either endoluminal stenting or to surgical decompression with or without resection of the primary tumour.

Objectives

CReST is a multi-centre Phase III randomised controlled trial with the following objectives:

Primary objectives:

To determine if endoluminal stenting for obstructing colonic cancers can result in:

  • Reduced perioperative morbidity as assessed by length of hospital stay
  • Reduced 30-day mortality

Secondary objectives:

To determine if endoluminal stenting for obstructing colonic cancers:

  • Reduces stoma formation
  • Improves quality of life
  • Increases ability to tolerate adjuvant chemotherapy
  • Has demonstrable benefits in the palliative and attempted curative settings
  • Improves overall survival

How to get involved...

If your site would like to participate in CReST, please download and complete the CReST Practical Arrangements Form and email to CReST@contacts.bham.ac.uk

If you have any queries about the trial, please get in touch using the contacts below:

E-mail : CReST@contacts.bham.ac.uk

Tel: 0121 415 9105

Fax: 0121 415 8871