title: How to decide to undertake a randomized, controlled trial of stent or surgery in colorectal obstruction.
abstract: BACKGROUND
  Colorectal stents have been available as a management option in obstruction for 23 years, yet there is little randomized evidence of their effectiveness. This study investigated current surgeon-related barriers to conducting a randomized, controlled trial (RCT) of colorectal stent insertion for obstruction in patients with colorectal cancer.
  
  
  METHODS
  A binational survey of current members of the Colorectal Surgical Society of Australia and New Zealand was conducted by a mailed questionnaire assessing perceived barriers to adoption of colonic stents and willingness to participate in future multicentre randomized controlled trials, and surgeons' treatment preferences in 16 hypothetical clinical scenarios.
  
  
  RESULTS
  Of 148 eligible surgeons, 96 (65%) responded. Colonic stenting was available to 98% of respondents. In the clinical setting of colorectal obstruction, only 29% (95% CI, 20-39%) of surgeons expressed a willingness to participate in a RCT involving colonic stents in the curative setting. More than 70% of surgeons preferred the use of stents in unfit patients for palliation, and preferred surgery in fit patients with curable disease. In the curative setting, most respondents considered colonic stents not cost effective (90%; 95% CI, 82-94%) and believed that their patients would not prefer stents over surgery (80%; 95% CI, 71-87%).
  
  
  CONCLUSIONS
  This study highlights the limitation to conducting a future randomized controlled trial to assess the efficacy of colonic stenting, especially in the curative setting, based on surgeon preference, despite the lack of level I evidence.
authors: Department of Colorectal Surgery, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, Sydney, Australia.
authors: Michael K L
authors: MK
authors: Suen
authors: Department of Colorectal Surgery, Royal Prince Alfred Hospital, NSW, Australia.
authors: Assad
authors: A
authors: Zahid
authors: Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Sydney, Australia.
authors: Jane M
authors: JM
authors: Young
authors: Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Sydney, Australia.
authors: Laura
authors: L
authors: Rodwell
authors: Department of Colorectal Surgery, Royal Prince Alfred Hospital, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Sydney, Australia.
authors: Michael J
authors: MJ
authors: Solomon
authors: Department of Colorectal Surgery, Royal Prince Alfred Hospital, NSW, Australia; University of Sydney, Sydney, Australia. Electronic address: cyoungnsw@aol.com.
authors: Christopher J
authors: CJ
authors: Young
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016001:Confidence Intervals; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D009520:New Zealand; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D015607:Stents / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome