Diverting Colostomy as a Bridge to Surgery Versus Emergency Primary Resection Without Anastomosis for Obstructive...

Area of Science:

• Colorectal surgery
• Surgical oncology
• Gastroenterology

Background:

• Malignant left-sided colon obstruction presents management challenges due to non-uniform treatment protocols.
• This study addresses the lack of standardized approaches for left colon cancer obstruction.

Purpose of the Study:

• To compare outcomes between immediate resection and primary colostomy for left-sided colon cancer obstruction.
• To evaluate the impact of lymphadenectomy quality and overall survival.
• To assess definitive stoma incidence, duration, morbidity, and hospital stay.

Main Methods:

• A 7-year retrospective cross-sectional study involving 127 patients with left colon neoplastic obstruction.
• Patients were divided into Primary Resection (PR) and Diverting Stoma (DS) groups for comparative analysis.

Main Results:

• No significant differences in patient characteristics, clinical signs, or obstruction severity were found.
• The DS group demonstrated superior resection and lymphadenectomy quality, harvesting more lymph nodes (14.9 vs. 12.8, p=0.012).
• The PR group had a higher rate of permanent stomas (42.4% vs. 9.4%, p<0.001) and longer stoma duration. Morbidity and mortality rates were similar between groups. DS was linked to increased recurrence-free survival.

Conclusions:

• Stoma diversion as a bridge to surgery appears to yield better oncological outcomes, including improved lymphadenectomy, compared to emergency resection for left-sided colon cancer.
• Diverting stoma management may be a preferred strategy for selected cases of malignant left-sided colon obstruction.