Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.
Endoscopy. 2021 Sep;53(9):905-913. doi: 10.1055/a-1308-1487. Epub 2020 Dec 18.
The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5 - 10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma.
This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria.
510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13 - 31) for SEMS and 36 days (IQR 22 - 65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11 - 17 days compared with 5 - 10 days. Of SEMS-related complications, 48 % occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14 - 28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated.
Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2 - 4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity.
左侧梗阻性结肠癌减压后行切除术的最佳时机尚不清楚。经修订的基于专家意见的指南推荐，减压后行切除术的时间间隔已从 5-10 天左右调整为自扩张金属支架（SEMS）放置后约 2 周，而对于减压造口后的推荐意见则有所欠缺。我们旨在评估 SEMS 后推荐的桥接间隔，并探讨减压造口后行切除术的时机。
本项全国性研究纳入了 2009 年至 2016 年期间在荷兰前瞻性强制性 ColoRectal Audit 登记的患者。通过 75 家医院的患者病历收集了额外数据。仅选择接受 SEMS 放置或减压造口作为手术桥梁的患者。技术上的 SEMS 失败和 48 小时内不成功减压为排除标准。
共纳入 510 例患者（SEMS 182 例，减压造口 328 例）。SEMS 的桥接间隔中位数为 23 天（四分位距 [IQR] 13-31），减压造口的桥接间隔中位数为 36 天（IQR 22-65）。SEMS 放置后，与 5-10 天相比，在 11-17 天后行切除术，在术后并发症、住院时间或腹腔镜切除术方面无显著差异。SEMS 相关并发症中，48%发生在手术时间超过 17 天的患者中。与 14 天内手术相比，减压造口后 14-28 天的间隔时间可显著增加腹腔镜切除术的比例、更多的一期吻合术和更短的住院时间。桥接间隔对死亡率、无病生存率或总生存率无影响。
根据对数据的全面评估，兼顾手术结果和不良事件的时间，SEMS 放置后大约 2 周的桥接间隔似乎较为合适，而在减压造口后等待 2-4 周则可进一步优化腹腔镜切除的手术条件，恢复肠连续性。
