Yokoyama Yuichiro, Emoto Shigenobu, Nozawa Hiroaki, Kawai Kazushige, Sasaki Kazuhito, Murono Koji, Ishibashi Rei, Koike Kazuhiko, Ishihara Soichiro
Department of Surgical Oncology University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan.
Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
Scand J Surg. 2022 Apr-Jun;111(2):14574969221096191. doi: 10.1177/14574969221096191.
Laparoscopic resection for obstructive colon cancer (CC) after insertion of self-expanding metallic stents (SEMSs) is reportedly difficult. However, this has not yet been thoroughly investigated. Therefore, we investigated the influence of SEMS insertion on laparoscopic resection.
This retrospective comparative study included 87 patients with obstructive left-sided CC (December 2011-December 2019). Patients were assigned to two groups based on elective laparoscopic surgery for (1) obstructive CC necessitating emergent decompression with SEMS insertion (SEMS group) and (2) obstructive CC without emergent decompression (control group).
The SEMS group had a longer operation time (283.3 ± 79.3 min vs 222.2 ± 79.4 min, = 0.002) and greater blood loss (204.8 ± 417.6 mL vs 53.7 ± 166.1 mL, = 0.029) on univariate analysis; however, in multiple linear regression analysis, SEMS was not an independent risk factor for both operation time (Δ operation time 25.5 min: = 0.19) and blood loss (Δ blood loss 33.6 mL: = 0.58). The complication rate based on Clavien-Dindo grade II did not differ significantly (17% vs 20%, = 1.00), whereas the rates of conversion to laparotomy (17% vs 2%, = 0.016) and stoma creation (26% vs 2%, = 0.001) were higher in the SEMS group. In oncological outcomes, there was no intergroup difference in the 5-year disease-free survival (80.0% vs 72.2%, = 0.76) and overall survival (100% vs 86.3%, = 0.25).
Laparoscopic surgery after SEMS for left-sided CC is demanding due to higher conversion rates to open surgery. However, this study also revealed that it is as safe as laparoscopic surgery for cases without SEMS because of comparable complication rate and long-term outcomes.
据报道，在插入自膨式金属支架（SEMS）后进行腹腔镜下梗阻性结肠癌（CC）切除术具有难度。然而，这一点尚未得到充分研究。因此，我们研究了SEMS插入对腹腔镜切除术的影响。
这项回顾性比较研究纳入了87例左侧梗阻性CC患者（2011年12月至2019年12月）。根据是否因梗阻性CC需要紧急减压并插入SEMS而接受择期腹腔镜手术，将患者分为两组：（1）需要插入SEMS进行紧急减压的梗阻性CC患者（SEMS组）；（2）无需紧急减压的梗阻性CC患者（对照组）。
单因素分析显示，SEMS组手术时间更长（283.3±79.3分钟 vs 222.2±79.4分钟，P = 0.002），失血量更大（204.8±417.6毫升 vs 53.7±166.1毫升，P = 0.029）；然而，在多元线性回归分析中，SEMS对于手术时间（手术时间增加25.5分钟：P = 0.19）和失血量（失血量增加33.6毫升：P = 0.58）均不是独立危险因素。基于Clavien-Dindo二级的并发症发生率无显著差异（17% vs 20%，P = 1.00），而SEMS组中转开腹率（17% vs 2%，P = 0.016）和造口率（26% vs 2%，P = 0.001）更高。在肿瘤学结局方面，两组间5年无病生存率（80.0% vs 72.2%，P = 0.76）和总生存率（100% vs 86.3%，P = 0.25）无差异。
对于左侧CC患者，在插入SEMS后进行腹腔镜手术因开腹手术转化率较高而具有挑战性。然而，本研究还表明，由于并发症发生率和长期结局相当，其与未插入SEMS的腹腔镜手术一样安全。
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