Lim Tian-Zhi, Chan Dedrick Kok Hong, Tan Ker-Kan
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Ann Surg Oncol. 2017 Jun;24(6):1618-1625. doi: 10.1245/s10434-016-5724-z. Epub 2017 Jan 4.
Stenting has been increasingly adopted in colorectal cancer patients presenting with acute large bowel obstruction. However, long-term outcomes of stenting are lacking in the literature. Our study attempts to compare the long-term outcomes of colonic stenting and emergency surgery amongst left-sided colorectal cancer patients presenting with acute large bowel obstruction.
A retrospective review of all patients who presented with nonmetastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed from January 2007 to April 2016. Patients were analysed in an intention-to-treat analysis.
Forty-seven (46.1%) patients underwent emergency surgery, whereas 55 (53.9%) underwent colonic stenting with a technical success rate of 71.0%. Patients who underwent emergency surgery were more likely to develop severe complications compared with patients who underwent successful colonic stenting, but the difference was not statistically significant (odds ratio [OR] 2.84; 95% confidence interval [CI] 0.71-11.3, p = 0.139). Patients were followed up for a median of 48.3 months (3.1-111) in the stenting group and 51.2 months (1.2-117.1) in the emergency surgery group. Recurrence rates between colonic stenting and emergency surgery were similar (25.6% vs. 21.3%, p = 0.500), with more anastomotic and peritoneal recurrences were noted in the emergency surgery group. 5 year disease free survival (77% vs. 73%, p = 0.708) and overall survival (86% vs. 62%, p = 0.064) also were similar.
Patients who underwent endoscopic stenting for large bowel obstruction have comparable long-term outcomes as those who undergo emergency surgery. The role of endoscopic stenting in obstructed colorectal cancers merits further evaluation.
对于出现急性大肠梗阻的结直肠癌患者，支架置入术的应用越来越多。然而，文献中缺乏支架置入术的长期疗效数据。我们的研究旨在比较左侧结直肠癌伴急性大肠梗阻患者行结肠支架置入术和急诊手术的长期疗效。
对2007年1月至2016年4月期间因非转移性结直肠癌行内镜支架置入术或急诊手术治疗急性大肠梗阻的所有患者进行回顾性研究。采用意向性分析对患者进行分析。
47例（46.1%）患者接受了急诊手术，55例（53.9%）患者接受了结肠支架置入术，技术成功率为71.0%。与成功进行结肠支架置入术的患者相比，接受急诊手术的患者更易发生严重并发症，但差异无统计学意义（优势比[OR]2.84；95%置信区间[CI]0.71 - 11.3，p = 0.139）。支架置入组患者的中位随访时间为48.3个月（3.1 - 111个月），急诊手术组为51.2个月（1.2 - 117.1个月）。结肠支架置入术和急诊手术的复发率相似（25.6%对21.3%，p = 0.500），急诊手术组吻合口和腹膜复发更多。5年无病生存率（77%对73%，p = 0.708）和总生存率（86%对62%，p = 0.064）也相似。
因大肠梗阻接受内镜支架置入术的患者与接受急诊手术的患者具有相似的长期疗效。内镜支架置入术在梗阻性结直肠癌中的作用值得进一步评估。
