预测因结外恶性肿瘤导致的恶性大肠梗阻患者的结肠支架的临床预后。
Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy.
机构信息
Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
出版信息
Gastrointest Endosc. 2018 May;87(5):1310-1317. doi: 10.1016/j.gie.2017.12.017. Epub 2018 Jan 4.
BACKGROUND AND AIMS
Colonic stent placement in patients with large-bowel obstruction (LBO) secondary to extracolonic malignancy (ECM) has been evaluated in small series with heterogeneous results. Our aim is to better characterize the technical and clinical success of colonic stent placement and to identify factors that affect this success in ECM patients.
METHODS
All patients at a single high-volume center who presented for colonic stent placement for LBO because of ECM between 2001 and 2012 were retrospectively identified. The outcomes of interest were technical success, clinical success, stent occlusion rate, and overall survival.
RESULTS
A total of 187 patients were identified. Mean age was 61.9 years (range, 23-89), and 150 (80.2%) were women. The most common malignancy type was urogynecologic (n = 104) and most common location sigmoid colon (n = 128). Overall, 142 patients (75.9%) achieved technical success and 102 patients (54.5%) clinical success. Radiographic presence of peritoneal carcinomatosis (P < .001) and multifocal disease (P < .001) were associated with both decreased technical and clinical success. Procedure-related adverse events were seen in 12 patients (6.4%). In patients with clinical success, the incidence of stent occlusion at 3 months was 14.7% (95% confidence interval, 7.8%-21.6%) and was higher in patients with prior radiation therapy (P = .011). The median overall survival for all patients from time of attempted stent placement was 3.3 months (95% confidence interval, 3.0-4.1).
CONCLUSIONS
This study represents the largest retrospective series of colonic stent placement for LBO in ECM patients in the literature. Our technical success rate of 75.9%, clinical success rate of 54.5%, and 3-month stent occlusion rate of 14.7% suggest that stent placement is a viable palliative option for patients with advanced disease because of ECM. Patients with peritoneal carcinomatosis and multifocal disease have reduced technical and clinical success. However, these factors should not dissuade an attempt at stent placement, if risk-to-benefit analysis is favorable.
背景与目的
在小系列研究中，已经评估了在继发于结外恶性肿瘤（ECM）的大肠梗阻（LBO）患者中放置结肠支架的效果，结果存在差异。我们的目的是更好地描述 ECM 患者中结肠支架放置的技术和临床成功率，并确定影响这一成功率的因素。
方法
回顾性分析了 2001 年至 2012 年期间，在单一高容量中心因 ECM 而出现 LBO 并接受结肠支架放置的所有患者。我们感兴趣的结局包括技术成功率、临床成功率、支架闭塞率和总生存率。
结果
共确定了 187 例患者。平均年龄为 61.9 岁（范围，23-89 岁），150 例（80.2%）为女性。最常见的恶性肿瘤类型为泌尿妇科（n=104），最常见的部位为乙状结肠（n=128）。总体而言，142 例（75.9%）患者达到技术成功，102 例（54.5%）患者达到临床成功。腹膜癌病（P<0.001）和多发病灶（P<0.001）的影像学表现与技术和临床成功率均降低相关。12 例（6.4%）患者发生与操作相关的不良事件。在临床成功的患者中，3 个月时支架闭塞的发生率为 14.7%（95%置信区间，7.8%-21.6%），且在接受过放射治疗的患者中更高（P=0.011）。所有患者从尝试支架放置到中位总生存时间为 3.3 个月（95%置信区间，3.0-4.1）。
结论
本研究是文献中最大的 ECM 患者结肠支架放置治疗 LBO 的回顾性系列研究。我们的技术成功率为 75.9%，临床成功率为 54.5%，3 个月时的支架闭塞率为 14.7%，这表明支架放置是一种可行的姑息治疗选择，适用于因 ECM 而处于晚期的患者。患有腹膜癌病和多发病灶的患者技术和临床成功率降低。然而，如果风险效益分析有利，这些因素不应阻止支架放置的尝试。
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