Pros and Cons of Decompressing Stoma Presurgery for Left-Sided Obstructive CRC

Decompressing stoma (DS) has advantages and disadvantages when compared with self-expandable metal stent (SEMS) as bridge to resection of left-sided obstructive colon cancer, findings from a cohort study suggest (JAMA Surg. 2020 Jan 8. Epub ahead of print).

“Bridge to elective surgery using…SEMS…placement is a debated alternative to emergency resection for patients with left-sided obstructive colon cancer because of oncologic concerns,” explained Joyce V. Veld, MD, MSc, Department of Surgery, Amsterdam University Medical Center, The Netherlands, who added that DS may be a valid alternative.

Citing a lack of relevant studies on the subject, Dr Veld et al sought to use propensity score matching to compare DS with SEMS as a bridge to surgery for nonlocally advanced left-sided obstructive colon cancer.

This population-based study was conducted at 75 hospitals across The Netherlands and comprised 4216 patients with left-sided obstructive colon cancer treated between January 1, 2009, and December 31, 2016.

Of these patients, 3153 (mean age, 69.7 years) were studied, with data spanning a median follow-up of 32 months.

The main outcome measures included primary anastomosis rate, presence of a stoma postsurgery, complications, additional interventions, permanent stoma, locoregional recurrence, disease-free survival, and overall survival. Analysis of data took place between April 7, 2019, and October 28, 2019.

Ultimately, 443 patients underwent bridge to surgery, including 240 who had DS and 203 who underwent SEMS. Propensity score matching led to 2 arms, with each comprising 121 patients.

SEMS was tied to more primary anastomoses, more postresection stomas, fewer major complications, and more subsequent interventions, including stoma reversal, than DS.

In addition, the 3-year locoregional recurrence rates following DS and SEMS were 11.7% and 18.8%, respectively (hazard ratio [HR], 0.62; 95% CI, 0.30-1.28; P = .20). The 3-year disease-free survival rates were 64.0% and 56.9%, respectively (HR, 0.90; 95% CI, 0.61-1.33; P = .60), and the 3-year overall survival rates were 78.0% and 71.8%, respectively (HR, 0.77; 95% CI, 0.48-1.22; P = .26).

“The findings suggest that DS as bridge to resection of left-sided obstructive colon cancer is associated with advantages and disadvantages compared with SEMS, with similar intermediate-term oncologic outcomes,” Dr Veld and colleagues said.

“The existing equipoise indicates the need for a randomized clinical trial that compares the 2 bridging techniques,” they concluded.—Hina Porcelli