Haraguchi Naotsugu, Ikeda Masataka, Miyake Masakazu, Yamada Takuya, Sakakibara Yuko, Mita Eiji, Doki Yuichiro, Mori Masaki, Sekimoto Mitsugu
Department of Surgery, National Hospital Organization Osaka National Hospital, Chuouku Hoenzaka 2-1-14, Osaka, 540-0006, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita Yamadaoka 2-2-E2, Osaka, 565-0871, Japan.
Surg Today. 2016 Nov;46(11):1310-7. doi: 10.1007/s00595-016-1333-5. Epub 2016 Apr 5.
To clarify the advantages and disadvantages of stenting as a bridge to surgery (BTS) by comparing the clinical features and outcomes of patients who underwent BTS with those of patients who underwent emergency surgery (ES).
We assessed technical success, clinical success, surgical procedures, stoma formation, complications, clinicopathological features, and Onodera's prognostic nutritional index (OPNI) in patients who underwent BTS and those who underwent ES.
Twenty-six patients underwent stenting, which was successful in 22 (BTS group). The remaining four patients with unsuccessful stenting underwent emergency surgery. A total of 22 patients underwent emergency surgery (ES group). The rates of technical and clinical success were 85.0 and 81.0 %, respectively. The proportion of patients able to be treated by laparoscopic surgery (P = 0.0001) and avoid colostomy (P = 0.0042) was significantly higher in the BTS group. Although the incidence of anastomotic leakage in the two groups was not significantly different, it was significantly reduced by colonoscopic evaluation of obstructive colitis (P = 0.0251). The mean number of harvested lymph nodes (P = 0.0056) and the proportion of D3 lymphadenectomy (P = 0.0241) were significantly greater in the BTS group. Perineural invasion (PNI) was noted in 59.1 and 18.2 % of the BTS group and ES group patients, respectively (P = 0.0053). OPNI and serum albumin decreased significantly after stenting (P = 0.0084).
The advantages of stenting as a BTS were that it avoided colostomy and allowed for laparoscopic surgery and lymphadenectomy, whereas its disadvantage lay in the decreased PNI and OPNI levels. A larger study including an analysis of prognosis is warranted.
通过比较接受手术桥接支架置入术（BTS）患者与接受急诊手术（ES）患者的临床特征和结局，阐明支架置入作为手术桥接的优缺点。
我们评估了接受BTS和ES的患者的技术成功率、临床成功率、手术方式、造口形成、并发症、临床病理特征和小野寺预后营养指数（OPNI）。
26例患者接受了支架置入术，其中22例成功（BTS组）。其余4例支架置入失败的患者接受了急诊手术。共有22例患者接受了急诊手术（ES组）。技术成功率和临床成功率分别为85.0%和81.0%。BTS组能够接受腹腔镜手术的患者比例（P = 0.0001）和避免结肠造口的患者比例（P = 0.0042）显著更高。尽管两组吻合口漏的发生率无显著差异，但通过结肠镜评估梗阻性结肠炎可使其显著降低（P = 0.0251）。BTS组的平均淋巴结清扫数量（P = 0.0056）和D3淋巴结清扫比例（P = 0.0241）显著更高。BTS组和ES组患者分别有59.1%和18.2%出现神经周围侵犯（PNI）（P = 0.0053）。支架置入后OPNI和血清白蛋白显著下降（P = 0.0084）。
支架置入作为BTS的优点是避免了结肠造口，允许进行腹腔镜手术和淋巴结清扫，而其缺点在于PNI和OPNI水平降低。有必要进行一项更大规模的研究，包括对预后的分析。
