Sugiura Kiyoaki, Seo Yuki, Aoki Hikaru, Onishi Yoshihiko, Nishi Yusuke, Kishida Norihiro, Tanaka Motomu, Ito Yasuhiro, Tokura Hideyuki, Takahashi Takayuki
Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan.
J Anus Rectum Colon. 2021 Jan 28;5(1):34-39. doi: 10.23922/jarc.2020-046. eCollection 2021.
Few studies have compared management and outcomes of bridge to surgery (BTS) for obstructive colonic cancer according to the location of the tumor. Additional information is needed about this procedure's characteristics and short-term and long-term outcomes. We aimed to compare patient and tumor characteristics, and outcomes of BTS for obstructive right-sided versus left-sided colonic cancers.
This was a retrospective, single center, cohort study. The study cohort comprised 149 patients, including 48 with right-sided and 101 with left-sided obstructive colonic cancers, who were treated with BTS between January 2007 and December 2017. Data on medical history, investigations, treatments, and prognosis were collected from an electronic database of a single hospital. The primary end points were overall (OS) and disease-free (DFS) survival and short-term surgical outcomes.
Significantly more patients with right-sided cancers had postoperative complications (29.2% vs. 14.9%, p = 0.039). Additionally, postoperative chemotherapy was administered to a marginally significantly greater proportion of patients with left-sided cancers (29.2% vs 45.5%, p = 0.057). The long-term outcomes were comparable between the two groups (the 5-year OS rates were 67.6% and 80.9% [p = 0.117] and the 5-year DFS rates were 62.2% and 58.6% [p = 0.671]). Multivariate analyses using all studied variables showed that lymphovascular invasion, advanced T stage, and adjuvant chemotherapy were independent poor prognostic factors.
The long-term outcome was not different between the right- and left-sided groups. In a BTS setting, postoperative complications may reduce the compliance of adjuvant chemotherapy in right-sided cancers and affect long-term outcomes.
很少有研究根据肿瘤位置比较梗阻性结肠癌的手术过渡（BTS）管理及结局。关于该手术的特点以及短期和长期结局，还需要更多信息。我们旨在比较梗阻性右半结肠癌和左半结肠癌患者及肿瘤特征，以及BTS的结局。
这是一项回顾性单中心队列研究。研究队列包括149例患者，其中48例为梗阻性右半结肠癌患者，101例为梗阻性左半结肠癌患者，他们于2007年1月至2017年12月期间接受了BTS治疗。从一家医院的电子数据库中收集了病史、检查、治疗和预后数据。主要终点为总生存期（OS）、无病生存期（DFS）和短期手术结局。
右侧癌症患者术后并发症显著更多（29.2%对14.9%，p = 0.039）。此外，左侧癌症患者接受术后化疗的比例略高（29.2%对45.5%，p = 0.057）。两组的长期结局相当（5年OS率分别为67.6%和80.9%[p = 0.117]，5年DFS率分别为62.2%和58.6%[p = 0.671]）。使用所有研究变量进行的多因素分析表明，淋巴管浸润、晚期T分期和辅助化疗是独立的不良预后因素。
右侧和左侧组的长期结局无差异。在BTS情况下，术后并发症可能会降低右侧癌症患者辅助化疗的依从性并影响长期结局。
