• Joyce V Veld, Femke J Amelung, Wernard A A Borstlap, Emo E van Halsema, ConstenEsther C JECJDepartment of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands.Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands., DekkerJan Willem TJWTDepartment of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD Delft, the Netherlands., Peter D Siersema, Frank Ter Borg, Edwin S van der Zaag, Paul Fockens, Willem A Bemelman, de WiltJohannes H WJHWDepartment of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands., Jeanin E van Hooft, Pieter J Tanis, and Dutch Snapshot Research Group.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
• Ann. Surg. 2020 Nov 1; 272 (5): 738-743.

ObjectiveThe purpose of this population-based study was to compare decompressing stoma (DS) as bridge to surgery (BTS) with emergency resection (ER) for left-sided obstructive colon cancer (LSOCC) using propensity-score matching.Summary Background DataRecently, an increased use of DS as BTS for LSOCC has been observed in the Netherlands. Unfortunately, good quality comparative analyses with ER are scarce.MethodsPatients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting, were propensity-score matched in a 1:2 ratio. The primary outcome measure was 90-day mortality, and main secondary outcomes were 3-year overall survival and permanent stoma rate.ResultsOf 2048 eligible patients, 236 patients who underwent DS were matched with 472 patients undergoing ER. After DS, more laparoscopic resections were performed (56.8% vs 9.2%, P < 0.001) and more primary anastomoses were constructed (88.5% vs 40.7%, P < 0.001). DS resulted in significantly lower 90-day mortality compared to ER (1.7% vs 7.2%, P = 0.006), and this effect could be mainly attributed to the subgroup of patients over 70 years (3.5% vs 13.7%, P = 0.027). Patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%, hazard ratio 0.36, 95% confidence interval 0.20-0.65) and fewer permanent stomas (23.4% vs 42.4%, P < 0.001).ConclusionsIn this nationwide propensity-score matched study, DS as a BTS for LSOCC was associated with lower 90-day mortality and better 3-year overall survival compared to ER, especially in patients over 70 years of age.

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