RISK-STRATIFIED COMPARISON OF BRIDGE TO SURGERY APPROACHES VERSUS EMERGENCY RESECTION IN PATIENTS WITH LEFT-SIDED OBSTRUCTIVE COLON CANCER: A NATIONWIDE 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, Weesp, Netherlands; 2University Medical Center 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: Bridge to surgery (BTS) techniques for left-sided obstructive colon cancer (LSOCC) have been extensively compared to emergency resection (ER). However, most studies did not investigate specific operative risk groups, such as elderly and frail patients. Therefore, the aim of the current population-based study was to perform a risk-stratified comparison of BTS by either stent or decompressing stoma with ER.
Methods: Patients with LSOCC treated between 2009-2016 were identified from the Dutch ColoRectal Audit, a mandatory, prospective national registry. Hereafter, 75 of 77 hospitals in the Netherlands retrospectively gathered additional data for each patient. Risk groups were created based on tumor characteristics (non-locally advanced [NLA] or locally advanced [LA]), age (< or ≥ 70 years), and ASA score (ASA I-II or ASA III-IV).
Results: A total of 2587 patients were included. BTS patients showed significantly fewer permanent stomas than ER patients in most risk groups, with absolute risk reductions varying from 9.5% in low-risk patients (NLA, < 70 years, ASA 1-2) to 42.7% in high-risk patients (LA, ≥ 70 years, ASA 3-4). No significant differences were observed in 90-day mortality in any of the risk groups, with mortality rates up to 18.8% for ER (NLA) and 14.6% for BTS (LA) in high-risk patients. No significant impact of BTS on disease free and overall survival was found in the stratified risk groups.
Conclusions: This risk-stratified, population-based study demonstrated fewer permanent stomas after BTS than ER for LSOCC, especially in elderly frail patients, without an impact on disease free and overall survival.
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