Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
Int J Colorectal Dis. 2019 Nov;34(11):1933-1943. doi: 10.1007/s00384-019-03413-z. Epub 2019 Oct 30.
Whether malignant colorectal obstruction (MCO) after one-stage curative surgery without preoperative decompression has a poor prognosis remains unclear. We assessed long-term outcomes of one-stage surgery without preoperative decompression for stage II/III MCO.
We retrospectively enrolled patients with stage II/III colorectal cancer (CRC) between April 2011 and December 2017. Propensity score-matched (PSM) analysis was used to reduce the possibility of selection bias.
In total, 464 stage II/III CRC patients were identified, of which 145 (31%) had obstruction (MCO group) and 319 (69%) did not (non-MCO group). In the MCO group, 59 (40.7%) had emergency MCO (E-MCO) and 86 (59.3%) had semi-emergency MCO (SE-MCO). The median follow-up was 37.0 (range 0-86.5) months. The tumor was deeper and larger, and serum carcinoembryonic antigen level was higher (p < 0.001, respectively) in the MCO group (including E-MCO and SE-MCO). Venous invasion-positivity rate was significantly higher (MCO and SE-MCO only, p = 0.003 and 0.009, respectively) than that in the non-MCO group. Laparoscopic surgery rate was significantly lower (MCO and E-MCO only, p < 0.001) than that in the non-MCO group. Before PSM, disease-free survival (DFS) of the SE-MCO patients was worse than that of the non-MCO patients (p = 0.046). After PSM, DFS was not significantly different between the non-MCO and MCO, E-MCO, and SE-MCO groups (p = 0.619, 0.091, and 0.308, respectively).
Long-term prognosis in patients with stage II/III MCO after one-stage surgery without preoperative decompression was similar to that in patients without MCO.
一期无术前减压根治术后合并恶性结直肠梗阻（MCO）的患者预后是否较差仍不清楚。我们评估了一期手术无术前减压治疗 II/III 期 MCO 的长期疗效。
我们回顾性纳入了 2011 年 4 月至 2017 年 12 月期间 II/III 期结直肠癌（CRC）患者。采用倾向评分匹配（PSM）分析以降低选择偏倚的可能性。
共纳入 464 例 II/III 期 CRC 患者，其中 145 例（31%）合并梗阻（MCO 组），319 例（69%）未合并梗阻（非 MCO 组）。在 MCO 组中，59 例（40.7%）为急诊 MCO（E-MCO），86 例（59.3%）为择期 MCO（SE-MCO）。中位随访时间为 37.0（0-86.5）个月。MCO 组（包括 E-MCO 和 SE-MCO）的肿瘤更深更大，血清癌胚抗原水平更高（p < 0.001），静脉侵犯阳性率也明显更高（仅在 MCO 和 SE-MCO 中，p = 0.003 和 0.009）。腹腔镜手术率明显低于非 MCO 组（仅在 MCO 和 E-MCO 中，p < 0.001）。PSM 前，SE-MCO 患者的无病生存率（DFS）较非 MCO 患者差（p = 0.046）。PSM 后，非 MCO 组与 MCO 组、E-MCO 组和 SE-MCO 组之间的 DFS 无显著差异（p = 0.619、0.091 和 0.308）。
一期无术前减压根治术后合并恶性结直肠梗阻患者的长期预后与无 MCO 患者相似。
