Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.
Surg Endosc. 2019 Apr;33(4):1225-1234. doi: 10.1007/s00464-018-6399-2. Epub 2018 Aug 27.
Colorectal stents are frequently used in patients with stage IV colorectal cancer with obstruction. However, there are only few studies on changes in outcomes of these patients and on the effect of stents on outcome over a long period of time with ongoing changes in therapeutic strategy, including chemotherapy.
We retrospectively evaluated 353 patients with bowel obstruction in stage IV colorectal cancer who underwent colonic stenting between years 2005 and 2014. The study population was divided into three groups based on time periods: 2005-2008, 2009-2011, and 2012-2014.
The frequency of colorectal stent insertion procedure increased over the time periods (13.8%, 18.3%, and 20.8%, respectively). There were no changes in success rate and total complication rate. However, the early complication rate in the 3rd period was significantly lower than in the other periods (15.4% vs. 17.1% vs. 7.2%; P = 0.039). In the multivariate analysis, carcinomatosis (hazard ratio, 1.478; 95% confidence interval, 1.016-2.149; P = 0.041) and covered or partial-covered stent (hazard ratio, 1.733; 95% confidence interval, 1.144-2.624; P = 0.009; hazard ratio, 1.988; 95% confidence interval, 1.132-3.493; P = 0.017, respectively) were associated with increased complication rate. Stent-related perforation was an independent risk factor related with increased mortality. Although survival duration increased over time (P = 0.042), the mortality rate was unchanged across the three time periods.
Over 10 years, the targeted agent use and survival duration increased, and early complication rate was decreased, without change in late complication rate or mortality rate during the three time periods in patients with obstructive stage IV colorectal cancer and stent insertion.
结直肠支架常用于伴有梗阻的 IV 期结直肠癌患者。然而，只有少数研究关注这些患者的结局变化，以及在治疗策略不断变化（包括化疗）的情况下，支架对长期结局的影响。
我们回顾性评估了 2005 年至 2014 年间接受结肠支架置入术的 353 例 IV 期结直肠癌伴梗阻患者。根据时间分为三组：2005-2008 年、2009-2011 年和 2012-2014 年。
支架置入术的频率随时间推移而增加（分别为 13.8%、18.3%和 20.8%）。成功率和总并发症率没有变化。然而，第 3 期的早期并发症发生率明显低于其他两个时期（15.4%比 17.1%比 7.2%；P=0.039）。多变量分析显示，癌转移（危险比，1.478；95%置信区间，1.016-2.149；P=0.041）和覆盖或部分覆盖支架（危险比，1.733；95%置信区间，1.144-2.624；P=0.009；危险比，1.988；95%置信区间，1.132-3.493；P=0.017）与并发症发生率增加相关。支架相关穿孔是与死亡率增加相关的独立危险因素。尽管生存时间随时间延长而增加（P=0.042），但三个时间段的死亡率没有变化。
在 10 年期间，靶向药物的使用和生存时间增加，早期并发症发生率降低，而在伴有梗阻的 IV 期结直肠癌和支架置入的三个时间段内，晚期并发症率或死亡率没有变化。
