Siddiqui A, Khandelwal N, Anthony T, Huerta S
Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, TX, USA.
Aliment Pharmacol Ther. 2007 Nov 15;26(10):1379-86. doi: 10.1111/j.1365-2036.2007.03513.x. Epub 2007 Sep 10.
Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency.
To compare the clinical outcomes and cost-effectiveness of endoscopic self-expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6-month period.
Decision analysis was used to calculate the cost-effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort).
Self-expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6-month period. Colonic SEMS was also associated with a lower mean cost per patient (USD 27,225 vs. USD 57,398). Mortality in the surgery group was 25 times that of the SEMS cohort. One- and two-way sensitivity analyses identified SEMS as the dominant strategy.
Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.
晚期结肠癌导致的急性结肠梗阻是一种外科急症。
比较内镜下自膨式金属支架（SEMS）与手术治疗转移性结直肠癌患者急性恶性结肠梗阻6个月期间的临床疗效和成本效益。
采用决策分析方法，计算在一名出现急性恶性结肠梗阻的转移性结肠癌假设患者中两种相互竞争策略的成本效益和成功率：（i）急诊结肠支架置入（SEMS组）；（ii）急诊手术切除并改行造口术（手术组）。
在6个月期间，与手术相比，自膨式金属支架置入成功率更高且死亡率更低。结肠SEMS还使每位患者的平均成本更低（27225美元对57398美元）。手术组的死亡率是SEMS组的25倍。单向和双向敏感性分析确定SEMS为主要策略。
对于转移性结肠癌患者的结肠梗阻治疗，结肠支架置入比手术更有效且成本更低。
