Tung Karen Lok Man, Cheung Hester Yui Shan, Ng Lawrence Wing Chiu, Chung Cliff Chi Chiu, Li Michael Ka Wah
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Asian J Endosc Surg. 2013 May;6(2):78-81. doi: 10.1111/ases.12030.
We previously conducted a randomized trial comparing the endo-laparoscopic approach (i.e. placing self-expanding metallic stents followed by laparoscopic resection) and conventional open surgery in the treatment of obstructing left-sided colon cancer. This study is a follow-up of the previous randomized trial and aims to report the long-term outcomes of the two groups.
Forty-eight patients from the randomized trial were followed up in an outpatient clinic with regular monitoring. Patients were compared for clinicopathological variables, disease recurrence and survival rates.
Clinicopathological details were comparable between the two groups. During the median follow-up periods of 32 months for the open group and 65 months endo-laparoscopic group, no statistically significant difference was observed between the groups in disease recurrence rate, 5-year overall survival (27% vs 48%, P = 0.076) and 5-year disease-free survival rates (48% vs 52%, P = 0.63).
Besides being a safe bridge to subsequent elective laparoscopic surgery, preoperative self-expanding metallic stents insertion does not adversely affect oncological outcomes and patient survival. Based on our data, the endo-laparoscopic approach is the treatment of choice for patients presenting with malignant left-sided colonic obstruction.
我们之前进行了一项随机试验，比较了内镜-腹腔镜联合手术方法（即先放置自膨式金属支架，随后进行腹腔镜切除术）与传统开放手术治疗左侧结肠癌梗阻的效果。本研究是之前随机试验的随访，旨在报告两组的长期结果。
对随机试验中的48例患者进行门诊随访并定期监测。比较两组患者的临床病理变量、疾病复发情况和生存率。
两组的临床病理细节具有可比性。开放手术组的中位随访期为32个月，内镜-腹腔镜联合手术组为65个月，两组在疾病复发率、5年总生存率（27%对48%，P = 0.076）和5年无病生存率（48%对52%，P = 0.63）方面均未观察到统计学显著差异。
术前插入自膨式金属支架除了是后续择期腹腔镜手术的安全桥梁外，不会对肿瘤学结局和患者生存产生不利影响。根据我们的数据，内镜-腹腔镜联合手术方法是左侧结肠癌恶性梗阻患者的首选治疗方法。
