Li Zhu-Lin, Wang Zhen-Jun, Han Jia-Gang, Yang Yong
Department of General Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing 100020, China.
World J Clin Cases. 2019 Feb 6;7(3):335-339. doi: 10.12998/wjcc.v7.i3.335.
Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.
The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography (CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis, and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly. Systemic chemotherapy with modified FOLFOX6 (mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.
This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.
欧洲胃肠内镜学会建议在支架置入后5 - 10天对梗阻性结肠癌进行手术。对于一些梗阻患者而言，这可能并非一个好的选择。在此，我们报告通过联合应用自膨式支架和新辅助化疗成功治疗梗阻性结肠癌的病例。
患者为一名72岁男性，因腹痛1个多月为主诉入院。计算机断层扫描（CT）显示降结肠有一肿块，导致肠梗阻。入院时，采取了一系列治疗措施，如禁食禁水、胃肠减压、全胃肠外营养和醋酸奥曲肽，以改善梗阻症状。同时，成功地在狭窄部位置入了自膨式金属支架，并进行了活检，诊断为腺癌。支架置入14天后的CT扫描显示肠道明显肿胀。给予改良FOLFOX6（mFOLFOX6）全身化疗。两个疗程的mFOLFOX6化疗后，CT扫描清楚显示肠道肿胀得到改善。随后，患者接受了左半结肠切除术，未行造口术。术后过程顺利，术后6个月无疾病复发。
这种改良的治疗策略可能为梗阻性结肠癌患者提供一种替代治疗方法。
