Is there a role for stents for patients with a new diagnosis of metastatic upper rectal cancer with a near-obstructing primary?  

I haven’t had much luck with stents - they hurt, they often migrate, and tumor growth or perforation is also a risk. My preferred approach is a diverting colostomy, then total neoadjuvant therapy, then resection with eventual ostomy takedown. (This assumes curative intent disease.) Of course, ...