Morino Mario, Arezzo Alberto, Farnesi Francesca, Forcignanò Edoardo
Department of Surgical Sciences, University of Torino corso Dogliotti 14, 10126 Torino, Italy.
Medicina (Kaunas). 2021 Apr 1;57(4):328. doi: 10.3390/medicina57040328.
Nowadays, colorectal cancer (CRC) is the third most frequent cancer, and about a third of patients with CRC presents themselves with symptoms of large bowel obstruction. Historically, surgical resection was the treatment of choice for colonic obstruction, but this kind of approach is burdened by a high risk of postoperative morbidity and mortality. In recent times, the use of a colonic stent has been proposed to overcome the obstruction and transform an emergency surgical case into an elective one to avoid emergency surgery complications. Endoscopic stenting is the first-line treatment option in the palliative management of colonic obstruction, and there is sufficient scientific evidence to support this approach. However, endoscopic stent used as a bridge to surgery is not yet widely adopted because the concern was raised about the long-term survival and cancer safety of this approach. The recent scientific evidence has shown that this approach improves the short-term outcomes, such as postoperative complications and the stoma rate, without differences in long-term outcomes compared to emergency surgery. Therefore, the European Society for Gastrointestinal Endoscopy in 2020 has reconsidered stenting as a bridge to surgery as a valid alternative to emergency surgery.
如今，结直肠癌（CRC）是第三大常见癌症，约三分之一的CRC患者会出现大肠梗阻症状。从历史上看，手术切除是结肠梗阻的首选治疗方法，但这种方法存在术后发病率和死亡率高的负担。近年来，有人提出使用结肠支架来克服梗阻，将急诊手术病例转变为择期手术，以避免急诊手术并发症。内镜支架置入是结肠梗阻姑息治疗的一线治疗选择，并且有足够的科学证据支持这种方法。然而，内镜支架用作手术桥梁的方法尚未被广泛采用，因为人们对这种方法的长期生存和癌症安全性表示担忧。最近的科学证据表明，与急诊手术相比，这种方法改善了短期结局，如术后并发症和造口率，且长期结局无差异。因此，欧洲胃肠内镜学会在2020年重新考虑将支架置入作为手术桥梁，作为急诊手术的有效替代方案。
