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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2019

01-03-2019 | Enterostomy | Colorectal Cancer

What is the Best Option Between Primary Diverting Stoma or Endoscopic Stent as a Bridge to Surgery with a Curative Intent for Obstructed Left Colon Cancer? Results from a Propensity Score Analysis of the French Surgical Association Multicenter Cohort of 518 Patients

Authors: Diane Mege, MD, PhD, Charles Sabbagh, MD, PhD, Gilles Manceau, MD, PhD, Valérie Bridoux, MD, PhD, Zaher Lakkis, MD, PhD, Diouf Momar, PhD, Igor Sielezneff, MD, PhD, Mehdi Karoui, MD, PhD, the AFC (French Surgical Association) Working Group

Published in: Annals of Surgical Oncology | Issue 3/2019

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Abstract

Background

Endoscopic stent (ES) as a bridge to surgery in obstructed left colon cancer (OLCC) is controversial. Our goal was to compare the operative and oncological results of primary diverting colostomy (PDC) and ES for the curative treatment of OLCC.

Methods

Between 2000 and 2015, patients who underwent PDC or ES in a curative intent for OLCC at member centers of the French Surgical Association were included. Patients with unresectable tumors and/or synchronous metastases were excluded. Comparisons between the two groups were performed after ponderation with propensity score for: demographic and tumor characteristics, operative, and oncological results.

Results

A total of 518 patients were included: PDC (n = 327); ES (n = 191). The demographic characteristics were similar between the groups. ES failed in 23% of the patients (11% perforation). Cumulative tumor resection rates were 80% and 86% after PDC and ES, respectively (p = 0.049). The rates of primary anastomosis were 57% in the PDC group and 40% in the ES group (p < 0.0001). The permanent stoma rates were similar between the two groups (29% vs. 28%, p = 0.0586). Cumulative overall, surgical, and medical complications were significantly higher in PDC group. The resected tumors were significantly smaller and less frequently perforated and metastatic in the PDC group. The median overall survival was significantly higher after PDC (123.6 vs. 58.5 months, p = 0.046), whereas the median disease-free survival was similar between the two groups (54.1 vs. 53.6 months, p = 0.646).

Conclusions

Although endoscopic stenting is associated with better surgical outcomes than diverting stoma, it may negatively impact histological features and overall survival.
Appendix
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Metadata
Title
What is the Best Option Between Primary Diverting Stoma or Endoscopic Stent as a Bridge to Surgery with a Curative Intent for Obstructed Left Colon Cancer? Results from a Propensity Score Analysis of the French Surgical Association Multicenter Cohort of 518 Patients
Authors
Diane Mege, MD, PhD
Charles Sabbagh, MD, PhD
Gilles Manceau, MD, PhD
Valérie Bridoux, MD, PhD
Zaher Lakkis, MD, PhD
Diouf Momar, PhD
Igor Sielezneff, MD, PhD
Mehdi Karoui, MD, PhD
the AFC (French Surgical Association) Working Group
Publication date
01-03-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-07139-0

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