Suárez Javier, Marín Gabriel, Vera Ruth, Colibaseanu Dorin, Vila Juan J, Ciga Miguel A, Oronoz Begoña
Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain.
J Surg Oncol. 2017 Jun;115(7):856-863. doi: 10.1002/jso.24588. Epub 2017 Feb 15.
Due to the potential risks associated with stent placement, European Society Gastrointestinal Endoscopy does not recommend prophylactic insertion of stents in patients without symptoms. The aim was to compare complication rates, need of surgery, colostomy formation, and survival between stent placement prior to start of chemotherapy (SEMS group) and upfront ChT (ChT group) in patients with endoscopically non-transverable metastatic left-sided colorectal cancer.
Gender, age, CEA, tumor location, sites of metastatic disease, peritoneal involvement, liver involvement, and angiogenesis inhibitors administration, were recorded. Complication rates, need of surgery, stoma creation, and survival were compared between both groups by univariate and multivariate test. Complications of SEMS placement in both groups were compared.
We studied 75 men and 40 women, with a mean age of 66.3 years. Overall complication and perforation rates were similar but patients in the ChT group had a significant higher need of surgery and subsequent stoma creation. Perforation after SEMS placement rates were higher in patients receiving ChT than in patients without ChT. Survival was related to peritoneal carcinomatosis and administration of biological agents.
SEMS placement prior to ChT administration dismissed the need of subsequent surgery and decreased the rates of permanent stoma formation.
由于支架置入存在潜在风险，欧洲胃肠内镜学会不建议对无症状患者进行预防性支架置入。本研究旨在比较内镜下无法切除的左侧转移性结直肠癌患者在化疗开始前进行支架置入（自膨式金属支架组）与直接进行化疗（化疗组）的并发症发生率、手术需求、结肠造口形成情况及生存率。
记录患者的性别、年龄、癌胚抗原、肿瘤位置、转移病灶部位、腹膜受累情况、肝脏受累情况及血管生成抑制剂的使用情况。通过单因素和多因素检验比较两组的并发症发生率、手术需求、造口形成情况及生存率。比较两组自膨式金属支架置入的并发症情况。
我们研究了75名男性和40名女性，平均年龄为66.3岁。总体并发症和穿孔率相似，但化疗组患者的手术需求及随后造口形成的需求显著更高。接受化疗的患者自膨式金属支架置入后的穿孔率高于未接受化疗的患者。生存率与腹膜癌病及生物制剂的使用有关。
化疗前进行自膨式金属支架置入消除了后续手术的需求，并降低了永久性造口形成的发生率。
