Introduction
death, primary bowel, cancer death, colon cancer, obstructive left-sided colon cancer, stoma, Colorectal cancer, colonic obstruction, obstructive cancer
COLONIC OBSTRUCTION, COLORECTAL CANCER, COLON CANCER, POSTOPERATIVE COMPLICATIONS
Colorectal cancer is the third leading cause of cancer death in both men and women in the USA [A study evaluating the Dutch surgical colorectal audit data between 2009 and 2013 found an overall mortality of 8.5% after emergency resection compared to 3.4% in elective surgery [A major burden for patients after emergency colon cancer resection is the development of postoperative complications, prolonged intensive care unit stay, permanent stoma, and in-hospital death. Patients undergoing emergency resection for obstructive cancer have a significant risk of permanent stoma [Several studies have suggested two-staged approaches with primary bowel decompression, either through the use of self-expanding metallic stents (SEMS) or placement of a decompressing stoma (DS) as a bridge-to-surgery (BTS). This approach aims to relieve colonic obstruction and allows patients to undergo elective oncological hemicolectomy after recovery. The BTS approach is considered a feasible and safe alternative to emergency resection with the goal of reducing postoperative complications [To date, only one randomized study has compared the use of a decompressing stoma as a bridge to surgery with emergency resection. Despite the study’s limitations, including a small patient cohort (A meta-analysis from 2015 summarizes the findings of eight comparative studies involving 2424 patients from 1977 to 2015 [A recent retrospective propensity-score matched study by Veld, Tanis et al. demonstrated that the use of a decompressing stoma as part of the BTS approach resulted in a significantly decreased 90-day mortality rate compared to emergency resection (1.7% vs. 7.2%, These findings collectively suggest that the BTS approach for obstructive left-sided colon cancer has the potential to decrease perioperative mortality and improve quality of life by reducing the need for permanent stomas without compromising long-term oncological outcomes. However, it should be noted that the retrospective nature of the studies mentioned above precludes a comprehensive evaluation of dropout rates between decompressing stoma placement and subsequent resection. Thus, a prospective randomized trial is necessary to conduct an intention-to-treat analysis and validate these findings.In this randomized multicenter trial, we aim to compare the outcomes of patients with obstructive left-sided colon cancer who undergo either emergency resection or the placement of a decompressing stoma as a bridge-to-surgery strategy.