Karoui Mehdi, Charachon Antoine, Delbaldo Catherine, Loriau Jérome, Laurent Alexis, Sobhani Iradj, Tran Van Nhieu Jeanne, Delchier Jean Charles, Fagniez Pierre-Louis, Piedbois Pascal, Cherqui Daniel
Department of Surgery, Service de Chirurgie Digestive, Hôpital Henri Mondor, 51 av du Maréchal de Lattre-de-Tassigny, 94010 Créteil CEDEX, France.
Arch Surg. 2007 Jul;142(7):619-23; discussion 623. doi: 10.1001/archsurg.142.7.619.
The more rapid and less complicated recovery after palliative stent insertion compared with surgery may theoretically facilitate the early administration of chemotherapy.
A retrospective study.
University tertiary care referral center.
From January 1, 1996, to September 15, 2005, 58 patients with obstructing colon cancer and nonresectable synchronous metastases were treated with self-expanding colonic metallic stent (SEMS) (n = 31) or surgery (n = 27).
Comparison of the use of SEMS and emergency surgery as palliative measures to treat obstructing colon cancer with special reference to time to chemotherapy administration and survival.
Mortality and morbidity were comparable between the 2 groups. Median hospital stay was shorter after SEMS insertion than after surgery (median, 8.0 vs 13.5 days, respectively; P < .01). Incidence of stoma creation was lower in patients treated with SEMS than in patients treated with surgery (6% vs 37%, respectively; P = .02). The median time to chemotherapy administration was shorter after SEMS insertion than after surgery (14.0 vs 28.5 days, respectively; P = .002). Three patients with SEMS and 0 patients in the surgical group underwent a curative colonic and hepatic resection after downstaging by chemotherapy (P = .27). Two patients (6%) with SEMS and undergoing chemotherapy had a tumor perforation requiring emergency surgery. There was no difference in survival between the 2 groups (median survival, 13.7 months for SEMS vs 11.4 months for surgery; P = .19).
Insertion of SEMS should be the first step to treat obstructing colon cancer with nonresectable synchronous metastases because it allows chemotherapy to be administered earlier, may increase the resectability rate of metastases, and favorably impacts survival. The risk of tumor perforation while receiving chemotherapy requires attention.
与手术相比，姑息性支架置入术后恢复更快且并发症更少，从理论上讲可能有助于早期进行化疗。
一项回顾性研究。
大学三级医疗转诊中心。
从1996年1月1日至2005年9月15日，58例患有梗阻性结肠癌且有不可切除同步转移灶的患者接受了自膨式结肠金属支架（SEMS）治疗（n = 31）或手术治疗（n = 27）。
比较使用SEMS和急诊手术作为姑息性措施治疗梗阻性结肠癌的情况，特别关注化疗给药时间和生存率。
两组的死亡率和发病率相当。SEMS置入术后的中位住院时间比手术术后短（分别为中位8.0天和13.5天；P <.01）。接受SEMS治疗的患者造口发生率低于接受手术治疗的患者（分别为6%和37%；P =.02）。SEMS置入术后化疗给药的中位时间比手术术后短（分别为14.0天和28.5天；P =.002）。3例接受SEMS治疗的患者和手术组0例患者在化疗降期后接受了根治性结肠和肝切除术（P =.27）。2例（6%）接受SEMS治疗且正在化疗的患者发生肿瘤穿孔，需要急诊手术。两组的生存率无差异（中位生存期，SEMS组为13.7个月，手术组为11.4个月；P =.19）。
对于患有不可切除同步转移灶的梗阻性结肠癌，SEMS置入应作为首要治疗步骤，因为它能使化疗更早进行，可能提高转移灶的可切除率，并对生存产生有利影响。化疗期间肿瘤穿孔的风险需要引起关注。
