Divisao de Endoscopia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Universidade de Sao Paulo, SP, BR.
Divisao de Cirurgia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Universidade de Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2020 Nov 11;75:e2046. doi: 10.6061/clinics/2020/e2046. eCollection 2020.
The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery.
This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group..
The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center.
No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.
20 多年前首次报道了将结直肠自膨式金属支架（SEMS）作为恶性结直肠梗阻的桥接治疗。然而，其应用仍存在争议。本研究旨在比较接受结直肠 SEMS 放置和急诊手术治疗的潜在可切除恶性结直肠梗阻患者的长期生存情况。
这是一项回顾性分析。纳入 2009 年至 2017 年接受治疗的患者。根据纳入标准，SEMS 组纳入 21 例患者，手术组纳入 67 例患者。
SEMS 组患者以女性为主（57.1%），而手术组患者以男性为主（53.7%）。两组的中位随访时间均为 60 个月，四分位距相同，为 60 个月。在五年分析中，总生存率（对数秩检验，p=0.873）和无病生存率（对数秩检验，p=0.2821）无差异。SEMS 组和手术组的局部复发率（38.1%比 22.4%，p=0.14）和远处复发率（33.3%比 50.7%，p=0.16）无差异。内镜下支架置入的技术和临床成功率分别为 95.3%和 85.7%。无即刻不良事件（AE）。严重 AE 包括穿孔（14.3%）、无症状穿孔（4.7%）、再梗阻（14.3%）和出血（14.3%）。轻度 AE 包括疼痛（42.8%）、里急后重（9.5%）和失禁（4.76%）。本研究的局限性在于回顾性研究，且仅在一家中心进行。
在接受 SEMS 放置或结肠造口术治疗恶性结直肠梗阻的可切除结直肠癌患者的五年分析中，无病生存率和总生存率无差异。SEMS 组患者的一期吻合率高于手术组，临时造口率低于手术组。
