Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan.
Department of Pathology, Toho University School of Medicine, 5-21-16 Omorinishi, Otaku, Tokyo, 143-8540, Japan.
World J Surg Oncol. 2018 Oct 17;16(1):210. doi: 10.1186/s12957-018-1509-0.
Surgical management of malignant bowel obstruction carries with high morbidity and mortality. Placement of a trans-anal decompression tube (TDT) has traditionally been used for malignant bowel obstruction as a bridge to surgery. Recently, colonic metallic stent (CMS) as a bridge to surgery for malignant bowel obstruction, particularly left-sided malignant large bowel obstruction (LMLBO) caused by colorectal cancer, has been reported to be both a safe and feasible option. The aim of this retrospective study is to evaluate the clinical effects of CMS for LMLBO as a bridge to surgery compared to TDT.
Between January 2000 and December 2015, we retrospectively evaluated outcomes of 59 patients with LMLBO. We compared the outcomes of 26 patients with CMS for LMLBO between 2013 and 2015 (CMS group) with those of 33 patients managed with TDT between 2003 and 2011 (TDT group) by the historical study. LMLBO was defined as a large bowel obstruction due to a colorectal cancer that was diagnosed by computed tomography and required emergent decompression.
All patients in the CMS group were successfully decompressed (p = 0.03) and could initiate oral intake after the procedure (p < 0.01). Outcomes in the CMS group were superior to the TDT group in the following areas: duration of tube placement (p < 0.01), surgical approach (p < 0.01), operation time (p < 0.01), number of resected lymph nodes (p < 0.001), and rate of curative resection (p < 0.01). However, no significant differences were found in the overall postoperative complication rate (p = 0.151), surgical site infection rate (p = 0.685), hospital length of stay (p = 0.502), and the need for permanent ostomy (p = 0.745). The 3-year overall survival rate of patients in the CMS and TDT groups was 73.0% and 80.9%, respectively, and this was not significant (p = 0.423).
Treatment with CMS for patients with LMLBO as a bridge to surgery is safe and demonstrated higher rates of resumption of solid food intake and temporary discharge prior to elective surgery compared to TDT. Oncological outcomes during mid-term were equivalent.
恶性肠梗阻的手术治疗具有较高的发病率和死亡率。传统上，经肛门减压管（TDT）的放置被用作手术的桥梁，用于恶性肠梗阻。最近，结肠金属支架（CMS）作为结直肠癌引起的左侧恶性大肠梗阻（LMLBO）的手术桥梁，已被报道为一种安全可行的选择。本回顾性研究旨在评估 CMS 作为 LMLBO 手术桥接治疗与 TDT 相比的临床效果。
2000 年 1 月至 2015 年 12 月，我们回顾性评估了 59 例 LMLBO 患者的结局。我们通过历史研究比较了 2013 年至 2015 年期间 26 例 CMS 治疗 LMLBO 患者（CMS 组）与 2003 年至 2011 年期间 33 例 TDT 治疗患者（TDT 组）的结局。LMLBO 定义为结直肠癌引起的大肠梗阻，通过计算机断层扫描诊断，需要紧急减压。
CMS 组所有患者均成功减压（p=0.03），术后可开始口服（p<0.01）。CMS 组在以下方面的结局优于 TDT 组：管放置时间（p<0.01）、手术方式（p<0.01）、手术时间（p<0.01）、切除淋巴结数量（p<0.001）和根治性切除率（p<0.01）。然而，两组总体术后并发症发生率（p=0.151）、手术部位感染率（p=0.685）、住院时间（p=0.502）和永久性造口术的需要（p=0.745）无显著差异。CMS 和 TDT 组患者的 3 年总生存率分别为 73.0%和 80.9%，差异无统计学意义（p=0.423）。
CMS 治疗 LMLBO 患者作为手术桥接是安全的，与 TDT 相比，固体食物摄入恢复率和择期手术前临时出院率更高。中期的肿瘤学结果相当。
