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

Malignant left-sided colon obstruction poses management challenges due to a lack of uniformity in its management. This study aimed to compare outcomes between immediate resection and primary colostomy, focusing on the impact of lymphadenectomy quality and overall survival. The secondary objectives included definitive stoma incidence, duration of stoma, morbidity, hospital stay, and morbidity.

A 7-year retrospective cross-sectional study of 127 patients with left colon neoplastic obstruction divided into Primary Resection (PR) and Diverting Stoma (DS) groups was conducted. The characteristics and outcomes of the two groups were compared.

Comparisons between the two groups revealed no significant differences in terms of patient characteristics, clinical and radiological signs, or obstruction severity. The DS group exhibited superior resection and lymphadenectomy quality, with more lymph nodes harvested (14.9 ± 1.4 vs. 12.8 ± 1.4, p = 0.012). The PR group had a longer stoma duration (344 ± 1.5 vs. 23.6 ± 1.8 days). The number of permanent stomas was greater in the PR group (42.4%) than in the DS group (9.4%), p < 0.001. The morbidity and mortality rates were similar (p > 0.05). No overall survival advantage was observed, although DS was associated with increased recurrence-free survival.

Stoma diversion as a bridge to surgery seems to provide better oncological outcomes with improved lymphadenectomy than does emergency resection.