Stent or stoma as a bridge to surgery in patients with acute malignant colorectal obstruction: a comparison of oncologic long-term results

Purpose: To evaluate the long-term oncologic results in patients treated for malignant left-sided colorectal obstruction with colonic stent or a deviating stoma as bridge to surgery. Methods: This was a single-center, retrospective cohort study comparing survival between 24 patients treated with stents for acute left-sided malignant obstruction and 32 patients who underwent a diverting stoma from 2003 to 2014. All patients subsequently underwent resection surgery with curative intent. Results: There were no significant differences between the two groups regarding age, sex, ASA classification, adjuvant chemotherapy, or tumor stage. Median time from acute treatment of obstruction to resection surgery was 30 days in the stent group and 55 days in the stoma group. There were no differences in 30-day complications between the two groups, neither for complications related to the stent or stoma intervention nor for overall complications. Stent-related perforation rate was 1/24 (4.2%). The cumulative 5-year overall survival was 63% in patients treated with a stent and 77% in patients treated with a stoma (p = 0.319). There were two cases of local recurrence in each group (p = 1.0). Conclusions: We found no differences in short-term complications or long-term oncologic outcomes between the two treatment groups. However, this may be due to a type II error, and larger studies are needed to confirm these results.