The "decompressing stoma - neoadjuvant Folfox chemotherapy - colectomy" strategy for non-metastatic obstructive colon...

Obstructive colon cancer (OCC) carries a poor prognosis, and the high morbidity of emergency resection often delays or precludes adjuvant chemotherapy. This study aimed to assess the feasibility and postoperative outcomes of a multimodal strategy combining decompression by diverting stoma, neoadjuvant chemotherapy (NAC), and elective colectomy in non-metastatic OCC.

Between 2016 and 2023, 41 patients with non-metastatic OCC were managed in four French centers using the sequence "decompressing stoma - systemic FOLFOX NAC - elective colectomy."

Eight patients with right-sided OCC underwent ileostomy. The median number of NAC cycles was 4 (range, 1-12), with grade ≥3 toxicity observed in 15%. One MSI patient switched to immunotherapy after one cycle. One patient experienced tumor progression during NAC and did not undergo surgery. Elective colectomy (n = 40) was performed by minimally invasive surgery in 73% of cases, with no mortality and 13% grade ≥3 morbidity. One patient had an R1 resection, and 2 (5%) achieved a pathological complete response (ypT0N0). Adjuvant chemotherapy was delivered in 78% of cases. After a median follow-up of 24.9 months (range, 6.4-78.8), 3-year overall and disease-free survival rates were 88% and 80%, respectively.

The sequence "decompressing stoma - FOLFOX NAC - colectomy" is safe, feasible, and may offer oncological benefit in non-metastatic OCC. Validation in a randomized phase III trial is warranted. The COnCERTO trial (ClinicalTrials.gov NCT06107920) is currently ongoing in France.