Department of Internal Medicine, Inje University Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Korean J Intern Med. 2023 Mar;38(2):186-194. doi: 10.3904/kjim.2022.281. Epub 2023 Jan 2.
BACKGROUND/AIMS: The optimal treatment for acute malignant obstruction of the proximal colon (MOPC, proximal to the splenic flexure) remains challenging. Emergency resection, the traditional modality for MOPC, has shown significantly high mortality and morbidity rates, according to recent studies. This study aimed to investigate the clinical outcomes of stent vs stoma as a bridge to curative surgery for MOPC.
This retrospective cohort study included 72 patients who underwent endoscopic placement of a self-expanding metallic stent (SEMS) or loop ileostomy for MOPC at six referral centers between January 2011 and July 2021. Clinical and pathological characteristics, procedure-related complications, and long-term mortality rates after curative surgery were analyzed.
During a mean follow-up period of 32 months, 30 patients (41.7%) underwent ileostomy preferentially for more proximal cancer, complete obstruction, and advanced tumor stage compared to the SEMS group. No difference was found in procedure-related complications, but five deaths were observed after ileostomy. Survival analysis for 5-year mortality after curative surgery showed no significant difference between the bridge modalities (log-rank p = 0.253).
In this study, SEMS as a bridge to surgery showed relatively safe results in terms of post-procedural mortality. However, these results should be considered when performing ileostomy in patients with more advanced malignant obstruction.
背景/目的：对于近端结肠（脾曲近端）急性恶性梗阻（MOPC）的最佳治疗方法仍然具有挑战性。根据最近的研究，MOPC 的传统治疗方法——紧急切除，显示出显著高的死亡率和发病率。本研究旨在探讨支架与造口术作为 MOPC 根治性手术桥接的临床效果。
本回顾性队列研究纳入了 2011 年 1 月至 2021 年 7 月期间在六个转诊中心接受内镜下放置自膨式金属支架（SEMS）或 Loop 肠造口术治疗 MOPC 的 72 例患者。分析了临床和病理特征、与操作相关的并发症以及根治性手术后的长期死亡率。
在平均 32 个月的随访期间，与 SEMS 组相比，30 例患者（41.7%）由于肿瘤更靠近近端、完全梗阻和晚期肿瘤分期而优先行肠造口术。与 SEMS 组相比，两组在与操作相关的并发症方面没有差异，但肠造口术后有 5 例死亡。根治性手术后 5 年死亡率的生存分析显示，桥接方式之间无显著差异（对数秩检验 p = 0.253）。
在这项研究中，作为手术桥接的 SEMS 在术后死亡率方面显示出相对安全的结果。然而，在对更晚期恶性梗阻患者进行肠造口术时，应考虑这些结果。
