Lim Tian-Zhi, Chan Dedrick Kok Hong, Tan Ker-Kan
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
J Gastrointest Oncol. 2018 Oct;9(5):785-790. doi: 10.21037/jgo.2018.06.03.
It remains contentious whether endoscopic stenting or upfront surgery is more optimal in patients with metastatic colorectal cancers presenting with large bowel obstruction.
A retrospective review of all patients with metastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed.
Between January 2007 and June 2014, 66 patients, median age, 64 (range, 25-96) years, presented with acute large bowel obstruction from metastatic colorectal cancer. Forty (60.6%) patients underwent endoscopic stenting whilst the rest received immediate upfront surgical intervention. Of the 40 patients, 29 (72.5%) were successfully stented. The remaining 11 (27.5%) patients who failed endoscopic stenting required immediate emergency surgery to relieve the obstruction. Patients who failed endoscopic stenting had worse complications than those patients who had their stents successfully inserted [odds ratio (OR), 23.3; 95% confidence interval (CI), 2.29-250.00, P=0.004]. Patients who underwent emergency surgery had a longer median length of stay than patients who had successful endoscopic stenting (P=0.003). The patients that underwent successful stenting had earlier commencement of chemotherapy compared to those who had upfront surgery (P=0.02). There was no difference in stoma creation rates between patients who had emergency surgery versus those who were successfully stented.
Stenting is a safe option in patients with stage IV colorectal cancer presenting with acute large bowel obstruction. Earlier commencement of chemotherapy occurs in patients who were successfully stented. Patients who failed stenting have equivalent outcomes to those who undergone upfront emergency surgery.
对于出现大肠梗阻的转移性结直肠癌患者，内镜支架置入术或直接手术哪种更为最佳仍存在争议。
对所有因急性大肠梗阻接受内镜支架置入术或急诊手术的转移性结直肠癌患者进行回顾性研究。
在2007年1月至2014年6月期间，66例患者（中位年龄64岁，范围25 - 96岁）因转移性结直肠癌出现急性大肠梗阻。40例（60.6%）患者接受了内镜支架置入术，其余患者接受了直接的急诊手术干预。在这40例患者中，29例（72.5%）成功置入支架。其余11例（27.5%）内镜支架置入失败的患者需要立即进行急诊手术以解除梗阻。内镜支架置入失败的患者比成功置入支架的患者并发症更严重[比值比（OR），23.3；95%置信区间（CI），2.29 - 250.00，P = 0.004]。接受急诊手术的患者中位住院时间比内镜支架置入成功的患者更长（P = 0.003）。与接受直接手术的患者相比，成功置入支架的患者化疗开始时间更早（P = 0.02）。急诊手术患者与成功置入支架患者之间造口形成率没有差异。
对于出现急性大肠梗阻的IV期结直肠癌患者，支架置入术是一种安全的选择。成功置入支架的患者化疗开始时间更早。支架置入失败的患者与接受直接急诊手术的患者预后相当。
