Zanghì A, Piccolo G, Cavallaro A, Pulvirenti E, Lo Menzo E, Cardì F, Di Vita M, Cappellani A
Department of Surgery, University of Catania, Catania, Italy.
Eur Rev Med Pharmacol Sci. 2016 Dec;20(24):5242-5248.
To evaluate the oncologic safety of colonic self-expandable metal stents (SEMS) in obstructive colon cancer.
We retrospectively reviewed all the patients who were treated with endoscopic placement of a self-expandable metallic stent (SEMS) at our institution.
A total of 26 patients were identified during the study period, of which 24 patients (92.30%) were treated with SEMS as a bridge-to-surgery and 2 (7.69%) as palliation. In 22 cases (80.76%), the stenosis was localized to the left side. Clinical success with resolution of bowel obstructions was achieved in 22 (84.61%) patients within a short period of time. Among patients treated successfully with SEMS insertion as bridge to surgery (n = 22), 20 (90.9%) underwent one-stage surgery with primary anastomosis while 2 patients (9.09%) underwent colostomy due to intraoperative evidence of a covered perforation by cancer tissue in the pelvis. Patients with subclinical perforation developed an early peritoneal carcinomatosis, 10 patients treated with curative intent subsequently developed liver metastasis after 24 months.
We reported an overall poor outcome among patients treated with the insertion of SEMS. This led us to think that, in some cases, occlusion may be better than a "silent" perforation.
评估结肠自膨式金属支架（SEMS）在梗阻性结肠癌中的肿瘤学安全性。
我们回顾性分析了在我院接受内镜下放置自膨式金属支架（SEMS）治疗的所有患者。
在研究期间共确定了26例患者，其中24例（92.30%）接受SEMS作为手术过渡治疗，2例（7.69%）接受姑息治疗。22例（80.76%）患者的狭窄位于左侧。22例（84.61%）患者在短时间内实现了肠梗阻缓解的临床成功。在成功接受SEMS插入作为手术过渡治疗的患者中（n = 22），20例（90.9%）接受了一期手术并进行了一期吻合，而2例（9.09%）因术中发现盆腔癌组织覆盖穿孔而接受了结肠造口术。亚临床穿孔患者发生了早期腹膜种植转移，10例接受根治性治疗的患者在24个月后出现了肝转移。
我们报告了接受SEMS插入治疗的患者总体预后较差。这使我们认为，在某些情况下，梗阻可能比“隐匿性”穿孔更好。
