Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
Int J Colorectal Dis. 2019 Apr;34(4):613-619. doi: 10.1007/s00384-019-03239-9. Epub 2019 Jan 16.
Stenting of obstructing colorectal cancers obviates the need for emergency surgery, reducing initial morbidity and mortality rate associated with emergency surgery and facilitates full staging of the neoplastic process with an opportunity to optimize the patient for surgery. Some recent publications have suggested however that this approach may be associated with higher local recurrence rates. We examined our outcomes following colonic stenting as a bridge to resection.
A database was reviewed (2006-2018) of patients presenting with acute colorectal obstruction that proceeded to endoscopic stenting. We assessed the bridge to surgery strategy, its success, complication rate, and impact on recurrence and survival.
Of a total of 103 patients who presented with acute malignant large bowel obstruction over this time period, 26 patients had potentially curable disease at presentation and underwent stenting as a bridge to surgery. The technical success rate for stenting in those managed as a bridge to surgery was 92% (n = 24/26) with 7.69% (n = 2/26) having a complication. There was one stent-related perforation. Median follow-up of this cohort was 31 months, with a 5-year overall survival of 53.5%.
Colorectal stenting as a bridge to resection is a successful management strategy for those presenting with obstructing colorectal obstruction. Selective use is associated with lower rates of stoma formation, greater rates of laparoscopic resections with low complication rates, and acceptable oncological outcomes.
阻塞性结直肠癌支架置入术可避免紧急手术的需要，降低与紧急手术相关的初始发病率和死亡率，并为肿瘤过程的全面分期提供便利，有机会优化患者的手术条件。然而，一些最新的出版物表明，这种方法可能与更高的局部复发率相关。我们检查了我们在结直肠支架置入术作为切除桥接方面的结果。
回顾了（2006-2018 年）患有急性结直肠梗阻并进行内镜下支架置入术的患者的数据库。我们评估了手术桥接策略、其成功率、并发症发生率以及对复发和生存的影响。
在这段时间内，共有 103 名患有急性恶性大肠梗阻的患者，其中 26 名患者在就诊时患有潜在可治愈的疾病，并进行了支架置入术作为手术桥接。在作为手术桥接管理的患者中，支架置入的技术成功率为 92%（n=24/26），并发症发生率为 7.69%（n=2/26）。有 1 例支架相关穿孔。该队列的中位随访时间为 31 个月，5 年总生存率为 53.5%。
结直肠支架置入术作为切除桥接是治疗阻塞性结直肠癌梗阻的一种成功的管理策略。选择性使用与造口形成率较低、腹腔镜切除术率较高、并发症发生率较低以及可接受的肿瘤学结果相关。
