85 The SSSLOT study: Surgery, Stent (SEMS), Stoma for Left Obstructive colonic Tumours

Aim

There is no clear consensus on the optimal management of obstructed left colonic malignancy. Although SEMS as a bridge to elective surgery is considered an alternative to primary surgery, comparisons of defunctioning stoma versus stent versus surgery has yet to be explored. This is a pilot study on the management of acute left malignant colonic obstruction (LMCO) in our trust.

Methods

This is a retrospective review of the management and outcomes of LMCO in our trust from 2019-2021.

Results

19 patients were identified (72 y.o., M:F 10:9). T3:4 (8:11). 3 were rectal, 11 sigmoid, 4 were descending, and 1 transverse colon cancer. 7 had SEMS, 7 defunctioning stoma, and 5 emergency resection.

All 7 cases of SEMS were clinically and technically successful. Mean time from SEMS to definitive surgery was 49.5 days with one case not leading to surgery. There was one 30-day complication reported which was not SEMS related; 3 year mortality (3YM) was 4/7.

In the defunctioning stoma group, 2 did not proceed to surgery; 6 patients experienced complications; 3YM was 3/7. For the straight to surgery group, 5/14 of patients who had bridging-to-surgery procedure had neoadjuvant treatment; 4 complications were reported; 3YM was 1/6.

Conclusion

Although the results are limited by small numbers, a bridge-to-surgery technique is used approximately 3 times more frequently than emergency surgery, and neoadjuvant treatment is rarely employed. There would appear to be a lower 3YM with emergency surgery compared to the other interventions. Multicenter data collection will assess these preliminary findings.