Maeda Hiromichi, Okamoto Ken, Uemura Sunao, Okabayashi Takehiro, Osaki Shinzou, Akimori Toyokazu, Kamioka Norihito, Hanazaki Kazuhiro, Kobayashi Michiya
Hepatogastroenterology. 2014 Oct;61(135):1938-41.
BACKGROUND/AIMS: The management for the obstructive left sided colorectal cancer is still controversial.
A retrospective study was performed on 249 consecutive patients who underwent surgical intervention for left sided colorectal cancer in our hospital. Among 36 patients who had colonic obstruction, 25 patients received tumor resection while the rest of the patients received palliative stoma creation. Clinical characteristics and outcome following tumor resection was compared between patients with and without colonic obstruction.
Prior to tumor resection, all patients received colonic decompression. Flowingly, 20 patients received staged surgeries and five patients underwent one stage surgery, with three of the latter requiring reoperation due to anastomotic leakage. The five-year overall survival rate for patients following tumor resection was 75.5 % and 69.1 % for those with and without colonic obstruction respectively. Log-rank test showed no significant difference in overall survival between the two groups (p = 0.91).
Onestage surgery for patients with obstructive colorectal cancer in our hospital was associated with frequent anastomotic leakage. Colonic obstruction itself may not be a poor prognostic factor when decompression preceded surgical resection.
背景/目的：左侧结直肠癌梗阻的治疗仍存在争议。
对我院249例接受左侧结直肠癌手术干预的连续患者进行回顾性研究。在36例结肠梗阻患者中，25例接受肿瘤切除，其余患者接受姑息性造口术。比较有和没有结肠梗阻的患者肿瘤切除后的临床特征和结局。
在肿瘤切除前，所有患者均接受结肠减压。顺利地，20例患者接受分期手术，5例患者接受一期手术，其中3例因吻合口漏需要再次手术。肿瘤切除后患者的五年总生存率分别为75.5%和69.1%，有和没有结肠梗阻的患者。对数秩检验显示两组总生存率无显著差异（p = 0.91）。
我院对梗阻性结直肠癌患者进行一期手术常伴有吻合口漏。当手术切除前进行减压时，结肠梗阻本身可能不是一个不良预后因素。
