Timing of restoration of bowel continuity after decompressing stoma, in left-sided obstructive colon cancer – A nationwide retrospective cohort

Abstract

Background: With increasing use of decompressing stoma as bridge to surgery for left-sided obstructive colon cancer, timing of restoration of bowel continuity (ROBC) is a subject of debate. There is a lack of data on immediate ROBC during elective resection as alternative for a 3-stage procedure. This study analysed if immediate ROBC during tumour resection is safe and of any benefit for patients who underwent decompressing stoma for left-sided obstructive colon cancer. Methods: In a Dutch nationwide collaborative research project, 3153 patients who underwent resection for left-sided obstructive colon cancer in 75 hospitals (2009-2016) were identified. Extensive data on disease and procedural characteristics, and outcomes was collected by local collaborators. For this analysis, 332 patients who underwent decompressing stoma followed by curative resection were selected. Immediate ROBC during tumour resection was compared to two no immediate ROBC groups, (1) tumour resection with primary anastomosis (PA) with leaving the decompressing stoma in situ, and (2) tumour resection without PA. Results: Immediate ROBC was performed in 113 patients (34.0%) and no immediate ROBC in 219 patients (168 with PA (50.6%) and 51 patients without PA (15.4%)). No differences at baseline between the groups were found for age, ASA score, cT and cM. Major surgical complications (8.8% immediate ROBC vs. 4.8% PA with decompressing stoma and 7.8% no PA; P=0.37) and mortality (2.7% vs. 2.4% and 0%, respectively; P=0.52) were similar. Immediate ROBC resulted in a shorter time with a stoma (mean 41 vs. 240 and 314 days, respectively; P<0.001), and fewer permanent stomas (7% vs. 21% and 80%, respectively; P<0.001) as compared to PA with decompressing stoma or no PA. Conclusion: After decompressing stoma for left-sided obstructive colon cancer, immediate ROBC during elective resection appears safe, reduces the total time with a stoma and the risk of a permanent stoma.