Use of ileostomy versus colostomy as a bridge to surgery in left-sided obstructive colon cancer: retrospective cohort study

Abstract

Background Colorectal cancer causes the majority of large bowel obstructions and surgical resection remains the gold standard for curative treatment. There is evidence that a deviating stoma as a bridge to surgery can reduce postoperative mortality rate; however, the optimal stoma type is unclear. The aim of this study was to compare outcomes between ileostomy and colostomy as a bridge to surgery in left-sided obstructive colon cancer. Methods This was a national, retrospective population-based cohort study with 75 contributing hospitals. Patients with radiological left-sided obstructive colon cancer between 2009 and 2016, where a deviating stoma was used as a bridge to surgery, were included. Exclusion criteria were palliative treatment intent, perforation at presentation, emergency resection, and multivisceral resection. Results A total of 321 patients underwent a deviating stoma; 41 (12.7 per cent) ileostomies and 280 (87.2 per cent) colostomies. The ileostomy group had longer length of stay (median 13 (interquartile range (i.q.r.) 10–16) versus 9 (i.q.r. 6–14) days, P = 0.003) and more nutritional support during the bridging interval. Both groups showed similar complication rates in the bridging interval and after primary resection, including anastomotic leakage. Stoma reversal during resection was more common in the colostomy group (9 (22.0 per cent) versus 129 (46.1 per cent) for ileostomy and colostomy respectively, P = 0.006). Conclusion This study demonstrated that patients having a colostomy as a bridge to surgery in left-sided obstructive colon cancer had a shorter length of stay and lower need for nutritional support. No difference in postoperative complications were found.

Does intestinal anastomosis in resection of colon cancer have a significant impact onto early postoperative outcome and long-term survival?

“…permits, a continuity resection should be performed. If this is not the case, a discontinuity resection and creation of an artificial intestinal outlet should be performed [ 3 ], in particular, in case of obstruction [ 4 ], as bridge to surgery [ 5 , 6 ] or in patients, who have an increased risk of non-reversal of the ostomy [ 7 ]. In contrast, no ostomy is considered one of the 6 health care parameters (in addition, surgery within 6 weeks, radical resection, lymph node (LN) yield ≥12, no adverse outcome and colonoscopy before/after surgery within 6 months), which belong to the definition of “textbook outcome” [ 8 ].…”