Decompressing stoma as bridge to resection effective in left-sided obstructive colon cancer

Symptomatic left-sided malignant colonic obstruction is a medical and surgical emergency. Emergency surgery (ES) is burdened by a high rate of anastomotic leak, assessed at between 18% and 33%. Recently, increased use of DS as BTS for LSOCC has been observed in the Netherlands. However, there is a lack of good quality comparative analyses on DS as BTS with ER. To fill this knowledge gap, researchers of Netherlands conducted a study to compare decompressing stoma (DS) as bridge to surgery (BTS) with emergency resection (ER) for left-sided obstructive colon cancer (LSOCC) using propensity-score matching.

Researchers enrolled 2048 patients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting. They were propensity-score matched in a 1:2 ratio, about 236 patients who underwent DS were matched with 472 patients undergoing ER.

Key findings of the study were:

♦ Researchers observed after DS more laparoscopic resections were performed (56.8%) and more primary anastomoses were constructed (88.5%).

♦ They reported, patients treated with DS had a significantly lower 90-day mortality (1.7%) when compared with ER (7.2%)

♦ They found similar findings with the subgroup of patients over 70 years (3.5% vs 13.7%)

♦ They also found patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%) and fewer permanent stomas (23.4% vs 42.4%) when compared with ER.

The authors concluded, "In this nationwide propensity-score matched study, DS as a BTS for LSOCC was associated with lower 90-day mortality and better 3-year overall survival compared to ER, especially in patients over 70 years of age".

For further information:

https://journals.lww.com/annalsofsurgery/Abstract/2020/11000/Decompressing_Stoma_a_s_Bridge_to_Elective_Surgery.11.aspx