Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Sci Rep. 2020 Jun 11;10(1):9502. doi: 10.1038/s41598-020-66508-6.
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs were 16.0%, 35.7%, and 30.2% in Groups 1, 2, and 3, respectively (P = 0.029). In multivariate analysis, the time interval for BTS was an independent risk factor for DFS (P < 0.001; HR, 14.463; 95% CI, 1.458-3.255) and OS (P = 0.027; HR, 4.917; 95% CI, 1.071-3.059). In conclusion, the perioperative short-term outcome was not affected by the time interval of BTS. However, elective surgery within 7 days after colonic stent might be suggested to balance the short-term benefits and long-term oncologic risks.
经结肠支架治疗梗阻性结肠癌后行桥接手术（BTS）尚未被接受为标准治疗策略。此外，对于 BTS 的最佳时间间隔也没有共识。我们旨在确定支架置入后行 BTS 的最佳时机，以降低肿瘤学风险。我们回顾性收集了来自五家医院的 174 例因 II 期或 III 期梗阻性结肠癌而行 BTS 的患者数据。我们根据支架置入后行 BTS 的时间间隔将患者分为三组：7 天内（第 1 组）、8-14 天（第 2 组）和 14 天以后（第 3 组）。主要结局是比较三组之间的肿瘤学结局，包括总生存（OS）、无病生存（DFS）和复发率（RR）。第 1、2 和 3 组分别有 75、56 和 43 例患者。第 1、2 和 3 组的术后发病率分别为 17.3%、10.8%和 9.3%（P=0.337）。RR 分别为 16.0%、35.7%和 30.2%（P=0.029）。多变量分析显示，BTS 的时间间隔是 DFS（P<0.001；HR，14.463；95%CI，1.458-3.255）和 OS（P=0.027；HR，4.917；95%CI，1.071-3.059）的独立危险因素。总之，BTS 的时间间隔不会影响围手术期的短期结果。然而，建议在结肠支架置入后 7 天内行择期手术，以平衡短期获益和长期肿瘤学风险。
