自膨式金属支架置入术在急性恶性右半结直肠梗阻择期手术与急诊手术中的桥接作用比较。
Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction.
机构信息
Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
出版信息
BMC Surg. 2020 Dec 10;20(1):326. doi: 10.1186/s12893-020-00993-4.
BACKGROUND
The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC.
METHODS
Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups.
RESULTS
In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858-12.370; P = 0.041).
CONCLUSION
Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.
背景
对于阻塞性结直肠癌患者，使用自膨式金属支架（SEMS）作为桥接手术的方法已经增加。然而，很少有报道比较 SEMS 作为右侧结肠癌急性恶性梗阻（MORC）的择期手术与急诊手术（ES）的桥接作用。本研究旨在评估 SEMS 放置后行择期手术与 ES 治疗急性 MORC 患者（包括 IV 期病例）的益处。
方法
回顾性纳入 2008 年 7 月至 2016 年 11 月在复旦大学中山医院接受原发性肿瘤根治性切除术的急性 MORC 患者。比较 SEMS 组和 ES 组之间的术后短期结局、无进展生存期（PFS）和总生存期（OS）。
结果
共纳入 107 例急性 MORC 患者（SEMS 组 35 例，ES 组 72 例）进行分析。SEMS 组 ICU 入院率较低（11.4%比 34.7%，P=0.011），并发症发生率较低（11.4%比 29.2%，P=0.042），术后住院时间明显较短（8.23±6.50 天比 11.18±6.71 天，P=0.033）。生存曲线显示两组之间的 PFS（P=0.506）或 OS（P=0.989）均无显著差异。此外，II 期和 III 期结肠癌患者的 PFS 和 OS 率之间也无显著差异。在 IV 期患者中，对于同时性肝转移进行结肠切除术后，SEMS 组和 ES 组的肝切除术率分别为 85.7%和 14.3%（P=0.029）。单独结肠切除术与联合切除术的风险比为 3.258（95%CI 0.858-12.370；P=0.041）。
结论
支架置入术在急性 MORC 患者的短期结局和预后方面具有显著优势。对于同时性肝转移，SEMS 置入术为原发性肿瘤和肝转移切除术做好更好的准备，有助于提高生存率。
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