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Multicenter Study
. 2020 Nov;272(5):738-743.
doi: 10.1097/SLA.0000000000004173.

Decompressing Stoma a s Bridge to Elective Surgery is an Effective Strategy for Left-sided Obstructive Colon Cancer: A National, Propensity-score Matched Study

Joyce V Veld  1   2 , Femke J Amelung  3 , Wernard A A Borstlap  1 , Emo E van Halsema  2 , Esther C J Consten  3   4 , Jan Willem T Dekker  5 , Peter D Siersema  6 , Frank Ter Borg  7 , Edwin S van der Zaag  8 , Paul Fockens  2 , Willem A Bemelman  1 , Johannes H W de Wilt  9 , Jeanin E van Hooft  2   10 , Pieter J Tanis  1 ; Dutch Snapshot Research Group
Affiliations
Multicenter Study

Decompressing Stoma a s Bridge to Elective Surgery is an Effective Strategy for Left-sided Obstructive Colon Cancer: A National, Propensity-score Matched Study

Joyce V Veld et al. Ann Surg. 2020 Nov.

Abstract

Objective: The purpose of this population-based study was 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.

Summary background data: Recently, an increased use of DS as BTS for LSOCC has been observed in the Netherlands. Unfortunately, good quality comparative analyses with ER are scarce.

Methods: Patients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting, were propensity-score matched in a 1:2 ratio. The primary outcome measure was 90-day mortality, and main secondary outcomes were 3-year overall survival and permanent stoma rate.

Results: Of 2048 eligible patients, 236 patients who underwent DS were matched with 472 patients undergoing ER. After DS, more laparoscopic resections were performed (56.8% vs 9.2%, P < 0.001) and more primary anastomoses were constructed (88.5% vs 40.7%, P < 0.001). DS resulted in significantly lower 90-day mortality compared to ER (1.7% vs 7.2%, P = 0.006), and this effect could be mainly attributed to the subgroup of patients over 70 years (3.5% vs 13.7%, P = 0.027). Patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%, hazard ratio 0.36, 95% confidence interval 0.20-0.65) and fewer permanent stomas (23.4% vs 42.4%, P < 0.001).

Conclusions: 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.

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References

    1. Jullumstro E, Wibe A, Lydersen S, et al. Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis 2011; 13:512–518.
    1. Veld JV, Amelung FJ, Borstlap WAA, et al. Changes in management of left-sided obstructive colon cancer: national practice and guideline implementation. J Natl Compr Canc Netw 2019; 17:1512–1520.
    1. Tanis PJ, Paulino Pereira NR, van Hooft JE, et al. Resection of obstructive left-sided colon cancer at a national level: a prospective analysis of short-term outcomes in 1,816 patients. Dig Surg 2015; 32:317–324.
    1. van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2014; 46:990–1053.
    1. Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 2014; 101:1751–1757.

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