Padwick Robert T, Chauhan Vishnusai, Newman Matthew, Francombe James, Osborne Martin J
Department of Colorectal Surgery, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK.
Department of Colorectal Surgery, South Warwickshire Hospitals NHS Foundation Trust, Warwick, UK.
ANZ J Surg. 2016 Oct;86(10):778-781. doi: 10.1111/ans.13614. Epub 2016 Apr 27.
Insertion of self-expanding metallic stents for obstructing colorectal cancer (CRC) is a potential alternative to emergency resection, but evidence regarding efficacy is inconclusive. We aim to assess local efficacy of stent insertion for obstructing CRC, and to establish whether the service could be offered regionally.
Retrospective patient data analysis using local paper notes and electronic records was performed. All patients underwent stent insertion for an obstructing CRC from April 2004 to March 2014. The main outcome measures were success of stent insertion, complications, further surgery and overall mortality.
Eighty-nine stent insertions were performed. Twenty-five were performed as a bridge to surgery, 49 due to advanced disease, 11 due to patient co-morbidity and four due to patient choice. Time from referral to stent insertion for emergency referrals was 1-360 h (median 23). Eighty-seven stents were successfully deployed. Perforation occurred in three patients and migration in nine patients. Twenty-one patients underwent planned surgery (time to surgery was 2-208 days, median 24), 14 patients underwent emergency surgery (time to surgery was 0-277 days, median 11). Forty-six patients have died since stent insertion (time to death was 0-42 months, median 6.04).
Stent insertion for obstructing CRC is a viable alternative to emergency resection, with a low complication rate. Stent insertion may allow a proportion of patients to later undergo planned surgery. Stent insertion carries a lower peri-procedure mortality than emergency resection. An acute stent insertion service for obstructing CRC could potentially be offered at regional level in our Trust.
对于梗阻性结直肠癌（CRC），插入自膨式金属支架是紧急切除手术的一种潜在替代方案，但关于其疗效的证据尚无定论。我们旨在评估插入支架治疗梗阻性CRC的局部疗效，并确定该服务是否可在区域范围内提供。
使用本地纸质病历和电子记录进行回顾性患者数据分析。所有患者在2004年4月至2014年3月期间因梗阻性CRC接受了支架插入术。主要观察指标为支架插入成功率、并发症、进一步手术情况及总体死亡率。
共进行了89次支架插入术。其中25次作为手术桥梁，49次因疾病进展，11次因患者合并症，4次因患者选择。紧急转诊患者从转诊到插入支架的时间为1 - 360小时（中位数23小时）。成功部署了87个支架。3例患者发生穿孔，9例患者出现支架移位。21例患者接受了计划性手术（手术时间为2 - 208天，中位数24天），14例患者接受了急诊手术（手术时间为0 - 277天，中位数11天）。自插入支架后，46例患者死亡（死亡时间为0 - 42个月，中位数6.04个月）。
对于梗阻性CRC，插入支架是紧急切除手术的可行替代方案，并发症发生率低。插入支架可能使一部分患者随后能够接受计划性手术。插入支架的围手术期死亡率低于紧急切除手术。在我们的信托机构中，有可能在区域层面提供针对梗阻性CRC的急性支架插入服务。
