Costa Santos Maria Pia, Palmela Carolina, Ferreira Rosa, Barjas Elídio, Santos António Alberto, Maio Rui, Cravo Marília
Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal.
General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal.
GE Port J Gastroenterol. 2016 Oct 4;23(6):293-299. doi: 10.1016/j.jpge.2016.06.003. eCollection 2016 Nov-Dec.
Colonic self-expandable metal stent placement is widely used for palliation of obstructive colorectal cancer. The European recommendations for stent placement as a bridge to elective surgery in obstructive colorectal cancer were recently reviewed. The aim of this study was to evaluate the efficacy and safety of stent placement in obstructive colorectal cancer and to discuss these recent guidelines.
Demographic characteristics, procedure indications, complications and final outcome in patients with obstructive colorectal cancer who underwent endoscopic stent placement between January 2012 and June 2015 were retrospectively analyzed. Statistical analysis was performed with SPSS V22.
Thirty-six patients were included, 20 (56%) women, mean age 70.6 ± 10.9 years. Stent placement as a bridge to elective surgery was performed in 75% (n = 27) of patients and with palliation intent in 25% (n = 9). In 94% (n = 34) of procedures, technical and clinical success was achieved. A total of eleven (11%) complications were observed: 2 migrations and 9 perforations. No procedure related death was recorded. When stents were placed as a bridge to surgery, average time between endoscopic procedure and surgery was 11.7 ± 9.4 days (excluding three patients who underwent neoadjuvant chemotherapy). Six perforations were recorded in this group: one overt and five silent (three during surgery and two after histopathological examination of the resected specimen). Twenty-one patients underwent adjuvant chemotherapy. During the follow-up period of 14.7 ± 10.9 months recurrence was observed in five patients. None of the recurrence occurred in the group of patients with perforation.
In this study, stent placement was an effective procedure in obstructive colorectal cancer. It was mainly used as a bridge to elective surgery. However, a significant rate of silent perforation was observed, which may compromise the oncological outcome of these potentially curable patients. Prospective real life studies are warranted for a better definition of actual recommendations.
结肠自膨式金属支架置入术广泛应用于梗阻性结直肠癌的姑息治疗。近期对欧洲关于将支架置入作为梗阻性结直肠癌择期手术桥梁的建议进行了回顾。本研究的目的是评估梗阻性结直肠癌支架置入的疗效和安全性，并讨论这些最新指南。
回顾性分析2012年1月至2015年6月期间接受内镜支架置入术的梗阻性结直肠癌患者的人口统计学特征、手术指征、并发症及最终结局。使用SPSS V22进行统计分析。
纳入36例患者，其中女性20例（56%），平均年龄70.6±10.9岁。75%（n = 27）的患者将支架置入作为择期手术的桥梁，25%（n = 9）的患者以姑息为目的。94%（n = 34）的手术取得了技术和临床成功。共观察到11例（11%）并发症：2例移位和9例穿孔。未记录到与手术相关的死亡。当支架作为手术桥梁置入时，内镜手术与手术之间的平均时间为11.7±9.4天（不包括3例接受新辅助化疗的患者）。该组记录到6例穿孔：1例明显穿孔和5例隐匿性穿孔（3例在手术期间，2例在切除标本的组织病理学检查后）。21例患者接受了辅助化疗。在14.7±10.9个月的随访期内，5例患者出现复发。穿孔患者组均未出现复发。
在本研究中，支架置入术是治疗梗阻性结直肠癌的有效方法。它主要用作择期手术的桥梁。然而，观察到隐匿性穿孔的发生率较高，这可能会影响这些潜在可治愈患者的肿瘤学结局。有必要进行前瞻性的实际研究以更好地确定实际建议。
