Use of ileostomy versus colostomy as a bridge to surgery in left-sided obstructive colon cancer: retrospective cohort study
Authors: Smalbroek Bo P , Weijs Teus J , Dijksman Lea M , Poelmann Floris B , Goense Lucas , Dijkstra Robert R , Wijffels Niels A T , Boerma Djamila , Smits Anke B ,   the Dutch Snapshot Research Group, Amelung F J , Consten E C J , Burghgraef T A , Hess D A , Roukema R , Demirkiran A , Tenhagen M , Straatman J , Nieuwenhuijzen G , Rutten H J T , Vugts G , Inberg B , Kreiter A , Scheurs S , Gerhards M F , Blom R L G M , Russchen M J A M , van den Berg A , Dekker J W T , Versteegh H P , Kloppenberg F W H , Bakker I S , Hamminga J T H , Konsten J L M , van Heinsbergen M , van Vugt S T , Bouwman J E , Heikens J T , van den Berg A , Takkenberg M , Graat L , Bastiaansen A J N M , Gorter E A , Merkus J W S , Boerma E G , Koolen L , Pierre D Jean , van der Harst E , Hogendoorn W , Wijngaarden L H , kortekaas R T J , Struijs M C , Heuchemer N , Fockens P , van Halsema E E , Borstlap W A A , Tanis P J , Veld J , Bemelman W A , Wisselink D D , Jongen A C H M , Schuermans V N E , Bouvy N D , Andeweg C S , Foppen J W , Heemskerk J , Scheerhoorn J , van der Sluis P , Smakman N , Bruns E R J , van der Zaag E S , Schuiten H J , Argillander T , Parry K , Lips D , Algera H , Poortman P , Steur C , Swank H A , Lamme B , Arron M N N J , van Uden D , Siersema P D , de Wilt J H W , Daniels L , Sonneveld D J A , Nielsen K , Masselink I , Holzik L M Lutke , Lo G , Menon A G , Lange J F , van Wely B J , van Esch A , Moes D E , Reuber B M M , Heijnen B H M , de Groot-van Veen I , van de Ven A W H , Marres C C M , Haak H E , Vermaas M , van Hagen P , van Westreenen H L , de Haas J W A , Klaase J M , van Veen M J F , Mearadji A , Heeren J , Silvis R , Tol J A M G , Molenaar C J L , van Essen J A , Lettinga T , Verkoele L , Beets G L , Zimmerman D D E , van Loon Y T , Oomen P , de Vries H S , van Hooft J E , Peeters K C M J , Boye N D A , ter Borg F , Talsma A K , Wijkmans A A , van Geloven A A W , van Oorschot N , Blomberg B , van Grevenstein W M U , Tolenaar J L , den Boer F C , Sierink J C , Paulides T , Reiber B M M , van de Beukel B , Tuynman J B , Bransma H T , Brandt-Kerkhof A R M , Bröker M E E , Crolla R M P H , van der Slegt J , Janssen T L , Werker C , Schuijt H J , Wiezer M J , van Dongen K , Kornmann V , Tseng L , Smit D , Sietses C , Visser T , Algie G D , Nieboer M J , Neijenhuis P A , Durmaz S F , Aufenacker T H J , Hugen N , van Basten Batenburg M , Westerterp M , van Groningen J , de Jong W J , Renger R J , Logeman F , Slooter G , Arts K , Wegdam J , Meisen G , Wiering B , van der Mijle H C J , Paulusma I , van der Sluis M , Havenga K , Burbach J P M , Furnee E J B , Polle B , Hoff C , Poelmann F , Zwols T L R , van Sprundel T C , Veltkamp S C , van de Wilt M , Vles W J , Kamman A , Schippers H , van der Hul R L , Breijer A , Kelder W , van den Hengel B , Klicks R , Kelling E F , Houdijk A P J , Heijnen L , Wit F , Dam M , Raber M , de Mey D J L M , van den Broek W , Verslijs L , de Klein G W , de Ruijter W M J , de Vos tot Nederveen Cappel R 
Published: May 2023

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.