Liang Jennifer, Church James M, Stocchi Luca, Fazio Victor, Kiran Ravi P
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
ANZ J Surg. 2014 Apr;84(4):275-9. doi: 10.1111/ans.12267. Epub 2013 Jul 25.
When patients with stage IV colorectal cancer are deemed to have an unresectable primary colorectal cancer or extensive metastases at surgery, bypass or stoma creation may be the only surgical options. Whether this surgical approach provides extra months of life or instead leads to prohibitive post-operative morbidity and mortality has not previously been well characterized. This study was conducted to evaluate early and long-term outcomes for stage IV colorectal cancer patients with unresectable primary tumour.
Patients with unresectable colorectal cancer who underwent palliative bypass or stoma creation were identified from a prospective colorectal cancer database. Early and long-term outcomes were evaluated. Survival was determined using Kaplan-Meier survival curves.
From 1980 to 2008, 81 patients with stage IV colorectal cancer had an unresectable primary or extensive metastases and underwent palliative bypass or stoma creation. Mean age was 61.5 ± 13.9 years, 44 (54.3%) were male. Location of the colorectal cancer was left-sided in 82.7%. Of the patients, 38.3% had emergency or urgent surgery. Sixty-two (76.5%) patients underwent a diverting stoma, 15 (18.5%) underwent enteric bypass procedures and 4 (4.9%) had both a diverting stoma and proximal bypass created. Twenty-five complications occurred in 24 patients (29.6%) with 2 patients (2.5%) requiring further re-operation. There was no anastomotic leak. Mean length of hospital stay was 13.8 ± 11.2 days. Thirty-day mortality rate was 16%. The median overall survival was 4.7 months, while the overall survival at 1 year was 24.7%. At 2 years, 6.1% patients were alive, all with a stoma.
Palliative bypass or stoma creation is associated with survival for several months for a significant proportion of patients with stage IV colorectal cancers, who have unresectable primaries or extensive metastases. The findings of this study support the use of bypass or diversion when faced with an unresectable primary in patients with colorectal cancer with metastases.
当IV期结直肠癌患者在手术时被认为原发性结直肠癌无法切除或存在广泛转移时，旁路手术或造口术可能是仅有的手术选择。这种手术方式是否能延长患者数月生命，还是会导致过高的术后发病率和死亡率，此前尚未得到充分描述。本研究旨在评估原发性肿瘤无法切除的IV期结直肠癌患者的早期和长期预后。
从一个前瞻性结直肠癌数据库中识别出接受姑息性旁路手术或造口术的无法切除的结直肠癌患者。评估其早期和长期预后。使用Kaplan-Meier生存曲线确定生存率。
1980年至2008年期间，81例IV期结直肠癌患者原发性肿瘤无法切除或存在广泛转移，接受了姑息性旁路手术或造口术。平均年龄为61.5±13.9岁，44例（54.3%）为男性。结直肠癌位于左侧的占82.7%。其中38.3%的患者接受了急诊或紧急手术。62例（76.5%）患者进行了转流造口术，15例（18.5%）接受了肠旁路手术，4例（4.9%）同时进行了转流造口术和近端旁路手术。24例患者（29.6%）发生了25例并发症，2例患者（2.5%）需要进一步再次手术。无吻合口漏。平均住院时间为13.8±11.2天。30天死亡率为16%。中位总生存期为4.7个月，1年总生存率为24.7%。2年时，6.1%的患者存活，均有造口。
对于相当一部分原发性肿瘤无法切除或存在广泛转移的IV期结直肠癌患者，姑息性旁路手术或造口术可使患者存活数月。本研究结果支持在面对有转移的结直肠癌患者原发性肿瘤无法切除时采用旁路手术或转流术。
