Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction — Efficacy, safety and long-term outcomes

Abstract Objective Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction. Methods Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010–2017. Results 48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p  vs 30%, p  vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95% CI:4.1–543.7), number of lymph nodes harvested (HR 0.9 95% CI:0.8–0.99) and adjuvant therapy (HR 0.1 95% CI:0.01–0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95% CI:1.1–47.6), number of lymph nodes harvested (HR 0.90, 95% CI:0.8–0.97), adjuvant therapy (HR 0.1, 95% CI:0.02–0.4) and surgery-related complications (HR 5.3, 95% CI:1.02–27.3) influenced overall survival. Conclusion Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.