Outcomes according to treatment modalities as a bridge to curative surgery for malignant obstruction of the proximal colon: stent versus stoma

• Published in: The Korean journal of internal medicine Vol. 38; no. 2; pp. 186 - 194
• Main Authors: Park, Yong Eun, Hong, Seung Min, Lee, Seung Bum, Lee, Hong Sub, Baek, Dong Hoon, Cha, Rari, Lee, Jong Yoon, Kim, Tae Oh, Lee, Jong Hoon
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association of Internal Medicine 01-03-2023; The Korean Association of Internal Medicine; 대한내과학회
• Subjects: Colonic Neoplasms - complications; Colonic Neoplasms - surgery; Colorectal Neoplasms; Humans; ileostomy; intestinal obstruction; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Original; Retrospective Studies; stents; Stents - adverse effects; Treatment Outcome; 내과학; Ileostomy; Intestinal obstruction; Stents
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2022.281

The optimal treatment for acute malignant obstruction of the proximal colon (MOPC, proximal to the splenic flexure) remains challenging. Emergency resection, the traditional modality for MOPC, has shown significantly high mortality and morbidity rates, according to recent studies. This study aimed to investigate the clinical outcomes of stent vs stoma as a bridge to curative surgery for MOPC.
This retrospective cohort study included 72 patients who underwent endoscopic placement of a self-expanding metallic stent (SEMS) or loop ileostomy for MOPC at six referral centers between January 2011 and July 2021. Clinical and pathological characteristics, procedure-related complications, and long-term mortality rates after curative surgery were analyzed.
During a mean follow-up period of 32 months, 30 patients (41.7%) underwent ileostomy preferentially for more proximal cancer, complete obstruction, and advanced tumor stage compared to the SEMS group. No difference was found in procedure-related complications, but five deaths were observed after ileostomy. Survival analysis for 5-year mortality after curative surgery showed no significant difference between the bridge modalities (log-rank p = 0.253).
In this study, SEMS as a bridge to surgery showed relatively safe results in terms of post-procedural mortality. However, these results should be considered when performing ileostomy in patients with more advanced malignant obstruction.