术前先行支架置入与直接手术治疗左侧梗阻性结直肠癌的肿瘤学结局比较

Oncologic outcomes of preoperative stent insertion first versus immediate surgery for obstructing left-sided colorectal cancer.

作者信息

Kang Sung Il, Oh Heung-Kwon, Yoo Jae Suk, Ahn Soyeon, Kim Min Hyun, Kim Myung Jo, Son Il Tae, Kim Duck-Woo, Kang Sung-Bum, Park Young Soo, Yoon Chang Jin, Shin Rumi, Heo Seung Chul, Lee In Taek, Youk Eui Gon, Kim Min Jung, Chang Tae Young, Park Sung-Chan, Sohn Dae Kyung, Oh Jae Hwan, Park Ji Won, Ryoo Seung-Bum, Jeong Seung-Yong, Park Kyu Joo

机构信息

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.

出版信息

Surg Oncol. 2018 Jun;27(2):216-224. doi: 10.1016/j.suronc.2018.04.002. Epub 2018 Apr 12.

DOI:10.1016/j.suronc.2018.04.002

PMID:29937174

Abstract

BACKGROUND

Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer.

METHODS

A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias.

RESULTS

One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730-1.548; Log-rank, p = 0.746) and the adjusted population (HR 0.122, 95% CI 0.920-1.987; Log-rank, p = 0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568-1.334; Log-rank, p = 0.526) and the adjusted population (HR 1.023, 95% CI 0.665-1.572; Log-rank, p = 0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p < 0.001).

CONCLUSION

The 'bridge to surgery' strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction.

摘要

背景

结肠自膨式金属支架置入术（SEMS）作为择期手术的桥梁，被广泛用于治疗恶性结肠梗阻。然而，结肠支架置入术对长期肿瘤学结局的影响存在争议。本研究旨在比较术前置入SEMS与直接手术治疗左侧结直肠癌梗阻患者的长期肿瘤学结局。

方法

分析了2004年至2011年期间在五家三级转诊医院接受根治性手术治疗左侧结直肠癌梗阻的连续患者队列。基于倾向评分，采用治疗权重逆概率方法对长期生存率进行分析和调整，以减少选择偏倚。

结果

109例患者接受了直接手术，226例患者在手术前接受了支架置入术。在未调整人群（风险比[HR]1.063，95%置信区间[CI]0.730 - 1.548；对数秩检验，p = 0.746）和调整人群（HR 0.122，95% CI 0.920 - 1.987；对数秩检验，p = 0.122）中，无病生存率均无显著差异。在未调整人群（HR 0.871，95% CI 0.568 - 1.334；对数秩检验，p = 0.526）和调整人群（HR 1.023，95% CI 0.665 - 1.572；对数秩检验，p = 0.916）中，总生存率也无显著差异。SEMS置入组的去功能造口形成率低于直接手术组（调整后，14.6%对41.3%，p < 0.001）。