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Annals of Surgical Oncology

, Volume 26, Issue 3, pp 756–764 | Cite as

What is the Best Option Between Primary Diverting Stoma or Endoscopic Stent as a Bridge to Surgery with a Curative Intent for Obstructed Left Colon Cancer? Results from a Propensity Score Analysis of the French Surgical Association Multicenter Cohort of 518 Patients

  • Diane Mege
  • Charles Sabbagh
  • Gilles Manceau
  • Valérie Bridoux
  • Zaher Lakkis
  • Diouf Momar
  • Igor Sielezneff
  • Mehdi KarouiEmail author
  • the AFC (French Surgical Association) Working Group
Colorectal Cancer

Abstract

Background

Endoscopic stent (ES) as a bridge to surgery in obstructed left colon cancer (OLCC) is controversial. Our goal was to compare the operative and oncological results of primary diverting colostomy (PDC) and ES for the curative treatment of OLCC.

Methods

Between 2000 and 2015, patients who underwent PDC or ES in a curative intent for OLCC at member centers of the French Surgical Association were included. Patients with unresectable tumors and/or synchronous metastases were excluded. Comparisons between the two groups were performed after ponderation with propensity score for: demographic and tumor characteristics, operative, and oncological results.

Results

A total of 518 patients were included: PDC (n = 327); ES (n = 191). The demographic characteristics were similar between the groups. ES failed in 23% of the patients (11% perforation). Cumulative tumor resection rates were 80% and 86% after PDC and ES, respectively (p = 0.049). The rates of primary anastomosis were 57% in the PDC group and 40% in the ES group (p < 0.0001). The permanent stoma rates were similar between the two groups (29% vs. 28%, p = 0.0586). Cumulative overall, surgical, and medical complications were significantly higher in PDC group. The resected tumors were significantly smaller and less frequently perforated and metastatic in the PDC group. The median overall survival was significantly higher after PDC (123.6 vs. 58.5 months, p = 0.046), whereas the median disease-free survival was similar between the two groups (54.1 vs. 53.6 months, p = 0.646).

Conclusions

Although endoscopic stenting is associated with better surgical outcomes than diverting stoma, it may negatively impact histological features and overall survival.

Notes

Collaborator list from the AFC working group

Aurélien Venara, Thibault Voron, Jean-Marc Regimbeau, Tatiana Codjia, Marie Dazza, Guillaume Gagnat, Servane Hamel, Laure Mallet, Paul Martre, Guillaume Philouze, Edouard Roussel, Pauline Tortajada, Anne Stéphanie Dumaine, Bruno Heyd, Zaher Lakkis, Brice Paquette, Nicola de’ Angelis, Francesco Esposito, Vincenzo Lizzi, Mehdi Ouaissi, Nicolas Michot, Quentin Denost, Christophe Tresallet, Oriana Tetard, Pauline Rivier, Elie Fayssal, Maxime Collard, David Moszkowicz, Frederique Peschaud, Jean Charles Etienne, Ludovic loge, Laura Beyer, Thierry Bege, Hélène Corte, Elsa D’Annunzio, Marine Humeau, Julien Issard, Nicolas Munoz, Julio Abba, Yaqoub Jafar, Laurence Lacaze, Pierre Yves Sage, Lilija Susoko, Bertrand Trilling, Catherine Arvieux, François Mauvais, Béatrice Ulloa Severino, Sophie Pitel, Arthus Vauchaussade de Chaumont, Bogdan Badic, Benjamin Blanc, Marine Bert, Paul Rat, Pablo Ortega-Deballon, Amélie Chau, Clémentine Dejeante, Christophe Mariette, Guillaume Piessen, Emilie Grégoire, Abdallah Alfarai, Jérémie-Henri Lefèvre, Magali Cabau, Anaelle David, Deborah Kadoche, Fanny Dufour, Géraldine Goin, Yvain Goudard, Ghislain Pauleau, Philippe Sockeel, Bruno De la Villeon, Karine Pautrat, Clarisse Eveno, Antoine Brouquet, Anne Cécile Couchard, Gregoire Balbo, Jean Yves Mabrut, Justine Bellinger, Martin Bertrand, Aurélie Aumont, Emilie Duchalais, Anne-Sophie Messière Adrien Tranchart, Jean-Baptiste Cazauran, Virginie Pichot-Delahaye, Vincent Dubuisson, Leon Maggiori, Bilem Djawad Boumediene, David Fuks, Xavier Kahn, Eve Huart, Jean Marc Catheline, Grégory Lailler, Oussama Baraket, Patrick Baque, Jean Marie Diaz de Cerio, Philippe Mariol, Bernard Maes, Philippe Fernoux, Philippe Guillem, Eric Chatelain, Charlotte de Saint Roman, Kévin Fixot.

Supplementary material

10434_2018_7139_MOESM1_ESM.jpg (22 kb)
Flowchart of patients admitted with obstructive left colonic cancer (OLCC) treated in a curative intent by primary diverting colostomy (PDC) or endoscopic stent (ES) (JPEG 21 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Diane Mege
    • 1
  • Charles Sabbagh
    • 2
  • Gilles Manceau
    • 3
  • Valérie Bridoux
    • 4
  • Zaher Lakkis
    • 5
  • Diouf Momar
    • 6
  • Igor Sielezneff
    • 1
  • Mehdi Karoui
    • 3
    Email author
  • the AFC (French Surgical Association) Working Group
  1. 1.Department of Digestive SurgeryTimone University HospitalMarseilleFrance
  2. 2.Department of Digestive SurgeryAmiens University HospitalAmiensFrance
  3. 3.Sorbonne University, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University HospitalParisFrance
  4. 4.Department of Digestive SurgeryCharles Nicolle University HospitalRouenFrance
  5. 5.Department of Digestive SurgeryBesançon University HospitalBesançonFrance
  6. 6.Department of Clinical Research and InnovationAmiens University HospitalAmiensFrance

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