Department of Digestive and Metabolic Surgery, North Hospital, Amiens University Medical Center, place Victor Pauchet, Amiens, France.
Ann Surg. 2013 Jul;258(1):107-15. doi: 10.1097/SLA.0b013e31827e30ce.
Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for left-sided malignant colonic obstruction (LMCO). However, the literature on the long-term impact of SEMS as "a bridge to surgery" is limited and contradictory.
From January 1998 to June 2011, we retrospectively identified patients operated on for LMCO with curative intent. The primary outcome criterion was overall survival. Short-term secondary endpoints included the technical success rate and overall success rate and long-term secondary endpoints included 5-year overall survival, 5-year cancer-specific mortality, 5-year disease-free survival, the recurrence rate, and mean time to recurrence. Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias.
There were 48 patients in the SEMS group and 39 in the surgery-only group. In the overall population, overall survival (P = 0.001) and 5-year overall survival (P = 0.0003) were significantly lower in the SEMS group than in the surgery-only group, and 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively (P = 0.02)). Five-year disease-free survival, the recurrence rate, and the mean time to recurrence were better in the surgery-only group (not significant). For patients with no metastases or perforations at hospital admission, overall survival (P = 0.003) and 5-year overall survival (30% vs 67%, respectively, P = 0.001) were significantly lower in the SEMS group than in the surgery-only group.
Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery.
自膨式金属支架（SEMS）置入术被认为是左半结肠癌梗阻（LMCO）急症手术的一种有前途的替代方法。然而，作为“手术桥梁”的 SEMS 的长期影响的文献有限且存在矛盾。
从 1998 年 1 月至 2011 年 6 月，我们回顾性地确定了接受根治性手术治疗的 LMCO 患者。主要终点标准是总生存。短期次要终点包括技术成功率和总体成功率，长期次要终点包括 5 年总生存率、5 年癌症特异性死亡率、5 年无病生存率、复发率和复发平均时间。采用意向治疗方法分析接受 SEMS 治疗的患者。使用倾向评分校正选择偏倚后，分析总生存率。
SEMS 组 48 例，手术组 39 例。在总体人群中，SEMS 组的总生存率（P = 0.001）和 5 年总生存率（P = 0.0003）明显低于手术组，SEMS 组的 5 年癌症特异性死亡率明显高于手术组（分别为 48%和 21%（P = 0.02））。手术组的 5 年无病生存率、复发率和复发平均时间更好（无显著差异）。对于入院时无转移或穿孔的患者，SEMS 组的总生存率（P = 0.003）和 5 年总生存率（分别为 30%和 67%，P = 0.001）明显低于手术组。
我们的研究结果表明，与立即手术相比，LMCO 患者接受 SEMS 置入术的总生存率较低。
