Zhang Jun-Rong, Hou Ping, Liao Tian-Ran, Wei Yong, Chen Xian-Qiang, Lin Bing-Qiang
Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001 Fujian, China.
Immunotherapy Institute, Fujian Medical University, No. 1 Xuefu Bei Road, Fuzhou, 350122 Fujian, China.
Gastroenterol Res Pract. 2019 Feb 3;2019:7418348. doi: 10.1155/2019/7418348. eCollection 2019.
Self-expanding metal stents (SEMS) have been increasingly used in patients with obstructive left-sided colorectal cancer (OLCC); however, stent-specific complications (e.g., perforations) might worsen the long-term survival outcome. Strict indication needed to be identified to confirm the benefit subgroups. This study was designed to explore the indication for emergency surgery (ES) and SEMS in patients with OLCC and to suggest optimal strategies for individuals.
After propensity score matching, 36 pairs were included. Perioperative and long-term survival outcomes (3-year overall survival (OS) and 3-year disease-free survival (DFS)) were compared between the ES and SEMS groups. Independent risk factors were evaluated among subgroups. Stratification survival analysis was performed to identify subgroups that would benefit from SEMS placement or ES.
The perioperative outcomes were similar between the SEMS and ES groups. The 3-year OS was comparable between the SEMS (73.5%) and ES (60.0%) groups, and the 3-year DFS in the SEMS group (69.7%) was similar to that in the ES group (57.1%). The pT stage was an independent risk factor for 3-year DFS ( = 0.014) and 3-year OS ( = 0.010) in the SEMS group. The comorbidity status ( = 0.049) independently affected 3-year DFS in the ES group. The 3-year OS rate was influenced by the cM stage ( = 0.003). Patients with non-pT4 stages in the SEMS group showed obviously better 3-year OS (95.0%) than the other subgroups. The 3-year OS rate was 36.4% in the ES group when patients had a worse comorbidity status than their counterparts.
SEMS might be preferred for patients of obstructive left-sided colorectal cancer in the "high-operative risk group" with existing comorbidities or those without locally advanced invasion, such as the non-pT4-stage status.
自膨式金属支架（SEMS）在左侧结直肠癌梗阻（OLCC）患者中的应用越来越广泛；然而，支架特异性并发症（如穿孔）可能会使长期生存结果恶化。需要确定严格的适应症以确认受益亚组。本研究旨在探讨OLCC患者急诊手术（ES）和SEMS的适应症，并为个体提出最佳策略。
在倾向评分匹配后，纳入36对。比较ES组和SEMS组的围手术期和长期生存结果（3年总生存（OS）和3年无病生存（DFS））。在亚组中评估独立危险因素。进行分层生存分析以确定将从SEMS置入或ES中受益的亚组。
SEMS组和ES组的围手术期结果相似。SEMS组（73.5%）和ES组（60.0%）的3年OS相当，SEMS组（69.7%）的3年DFS与ES组（57.1%）相似。pT分期是SEMS组3年DFS（ = 0.014）和3年OS（ = 0.010）的独立危险因素。合并症状态（ = 0.049）独立影响ES组的3年DFS。3年OS率受cM分期影响（ = 0.003）。SEMS组中非pT4期患者的3年OS（95.0%）明显优于其他亚组。当ES组患者合并症状态比对照组差时，其3年OS率为36.4%。
对于存在合并症的“高手术风险组”或无局部晚期浸润（如非pT4期）的左侧结直肠癌梗阻患者，SEMS可能是更好的选择。
