DECOMPRESSING STOMA VERSUS EMERGENCY RESECTION FOR LEFT-SIDED OBSTRUCTIVE COLON CANCER: A NATIONWIDE, PROPENSITY SCORE MATCHED STUDY
Joyce Veld*1, Femke J. Amelung2,3, Wernard Borstlap1, Emo E. van Halsema1, Esther Consten3,4, Peter D. Siersema5, Frank ter Borg6, Edwin van der zaag7, Paul Fockens1, Willem A. Bemelman1, Jeanin E. Van Hooft1, Pieter J. Tanis1
1Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; 2UMC Utrecht, Utrecht, Netherlands; 3Meander Medical Center, Amersfoort, Netherlands; 4University Medical Center Groningen, Groningen, Netherlands; 5Radboud University Medical Center, Nijmegen, Netherlands; 6Deventer Ziekenhuis, Deventer, Netherlands; 7Gelre Hospital, Apeldoorn, Netherlands
Background and Aims: Recent nationwide analyses have revealed an increase in the use of decompressing stoma (DS) as bridge to surgery (BTS) as an alternative to emergency resection (ER) for left-sided obstructive colon cancer (LSOCC). In addition, DS more often resulted in a two-stage procedure by closing the stoma directly after tumor resection. Although in line with revised national guideline recommendations, supporting evidence for DS as BTS remains scarce. Therefore, we aimed to compare DS as BTS and ER for LSOCC at a population level using propensity score matching.
Methods: Patients treated for LSOCC between 2009 and 2016 were selected from the Dutch ColoRectal Audit, a mandatory, prospective national registry. Through a collaborative research project involving 75 of 77 Dutch hospitals, additional diagnostic, procedural, and long-term outcomes were retrospectively collected by individual patient file review. Patients were excluded in case of palliative treatment intent, signs of bowel perforation on CT scan, colonic stent placement as BTS and locally advanced tumors. Patients treated with DS or ER were compared after propensity score matching. Main outcomes included 90-day mortality and 3-year overall survival. One-to-two nearest neighbor matching without replacement was performed to balance baseline characteristics. Due to the paired nature of the data, outcomes were compared with conditional logistic regression. Survival analyses were performed with Cox proportional hazards with shared frailty. Analyses were based on intention-to-treat. A two-sided P-value <0.05 was considered significant.
Results: In total, 240 DS as BTS and 1808 ER patients were included. Two-to-one propensity score matching resulted in 236 DS and 472 ER patients with a median follow-up of 26 and 25.5 months, respectively (p=0.064). Compared to ER, DS resulted in more laparoscopic resections (56.8% versus 9.2%, p<0.001) and more primary anastomoses (88.5% versus 40.7%, p<0.001). DS patients had a lower risk of 90-day mortality (1.7% versus 7.3%, p=0.006) and better 3-year overall survival (79.4% versus 73.3%, HR 0.36, 95% CI 0.20-0.65, p<0.001). Resection-related complication (23.6% versus 37.5%, p<0.001), anastomotic leakage (3.4% versus 9.9%, p=0.018), major complication (9.0% versus 15.1%, p=0.027), and permanent stoma rates (18.8% versus 33.4%, p<0.001) were lower after DS, with shorter post-resection hospital stay (median 6 versus 11 days, p<0.001).
Conclusions: Apart from fewer complications and fewer permanent stomas, this population-based study revealed a reduced post-operative mortality and better 3-year overall survival for DS as BTS than ER in patients with LSOCC.
Back to 2020 Abstracts