title: Should patients With obstructing colorectal cancer have proximal diversion?
abstract: BACKGROUND
  Up to 20% of patients with colorectal cancer present with obstruction. The goal of this study was to compare the short-term outcomes of patients with obstructing colon cancer who underwent resection and primary anastomosis with or without proximal diversion.
  
  
  METHODS
  The American College of Surgeons' National Surgical Quality Improvement Program Procedure Targeted Colectomy databases from 2012 to 2014 were reviewed. Patients undergoing colorectal resection with or without diverting ostomy for obstructing colorectal cancer were analyzed. Propensity score-matched cohorts of diverted and nondiverted patients were created accounting for patient characteristics. The primary outcomes were 30-day mortality, postoperative complications, and readmission.
  
  
  RESULTS
  There were 2,323 patients (92%) with no proximal diversion and 204 patients (8%) with proximal diversion. In univariate analysis, patients with colorectal resection with diversion were significantly more likely to have any complication (P = .001), sepsis (P = .01), and blood transfusion (P = .001). Diversion patients were also significantly more likely to be readmitted to the hospital within 30 days of the index procedure (P = .02). Proximal diversion was associated with any complication (P = .01), failure to wean off ventilator (P = .05), and longer length of stay (P = .01) in matched cohorts.
  
  
  CONCLUSIONS
  Proximal diversion in the setting of obstructive colorectal cancer is associated with higher rates of any complication, deep wound infection, sepsis, and readmission. Surgeons who perform a primary anastomosis with diversion for obstructing colorectal cancer should take into account the significant risk for postoperative complications.
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Chaya
authors.initials: C
authors.lastname: Shwaartz
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Fields
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jake G
authors.initials: JG
authors.lastname: Prigoff
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Aalberg
authors.affiliation: Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: celia.divino@mountsinai.org.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D057216:Propensity Score; D012189:Retrospective Studies; D015300:Ventilator Weaning
keywords: Colorectal cancer; Complications; Diversion; Obstruction; Stoma