Department of Colorectal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Surg Today. 2023 Apr;53(4):459-469. doi: 10.1007/s00595-022-02623-3. Epub 2022 Nov 27.
This study surveyed the current practice of surgical treatment of obstructive left-sided colon cancer (OLCC) in China.
All colorectal surgery departments at tertiary or secondary hospitals in China were invited to complete a web-based questionnaire between August 27 and September 2, 2020.
Overall, completed questionnaire were received from 357 hospitals. Emergency surgery was the mainstay of treatment for OLCC, with the open approach accounting for up to 61.62%. The stoma rate of emergency surgery was up to 80%, mainly due to inadequate bowel preparation and severe edema of colon walls. Hartmann's procedure (61.62%) was the most preferred operation. A total of 243 hospitals (68.7%) reported that they would consider the use of a self-expanding metallic stent (SEMS) as a bridge for elective surgery. More than 50% of the hospitals participating in this study reported the success rate of SEMS placement, as well as the resolution rate of obstruction more than 80%, and the stent-related perforation rate was < 5%. A total of 126 hospitals considered carrying out a strategy of SEMS followed by neoadjuvant chemotherapy prior to elective surgery and believed that it might further improve treatment outcomes.
SEMS is a feasible option for the treatment of OLCC in addition to traditional emergency surgery, and its clinical benefits have been preliminarily recognized.
本研究调查了中国目前治疗左侧结直肠癌（OLCC）的手术治疗方法。
2020 年 8 月 27 日至 9 月 2 日，邀请中国所有三级或二级医院的结直肠外科部门完成在线问卷调查。
共收到 357 家医院的有效问卷。OLCC 的主要治疗方法是急诊手术，其中开放手术占比高达 61.62%。急诊手术的造口率高达 80%，主要是由于肠道准备不充分和结肠壁严重水肿。Hartmann 手术（61.62%）是最常选择的手术。共有 243 家医院（68.7%）表示可能会考虑使用自膨式金属支架（SEMS）作为择期手术的桥梁。超过 50%的参与研究的医院报告了 SEMS 放置的成功率、梗阻缓解率超过 80%，支架相关穿孔率<5%。共有 126 家医院考虑在择期手术前采用 SEMS 联合新辅助化疗的策略，并认为这可能进一步改善治疗效果。
SEMS 是传统急诊手术之外治疗 OLCC 的一种可行选择，其临床获益已初步得到认可。
