Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-Do, 13620, South Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Surg Endosc. 2023 May;37(5):3873-3883. doi: 10.1007/s00464-023-09891-1. Epub 2023 Jan 30.
Self-expanding metallic stenting (SEMS) is usual for the temporary resolution of obstructive left-sided colorectal cancer (CRC) as a bridge to elective surgery. However, there is no consensus regarding adequate time intervals from stenting to radical surgery. The aim of this study was to identify the optimal time interval that results in favorable short- and long-term outcomes.
Data on patients with obstructive left-sided CRC who underwent elective radical surgery after clinically successful SEMS deployment in five tertiary referral hospitals from 2004 to 2016 were analyzed, retrospectively. An inverse probability treatment-weighted propensity score analysis was used to minimize bias. Postoperative short- and long-term outcomes were compared between two groups: an early surgery (within 8 days) group and delayed surgery (after 8 days) group.
Of 311 patients, 148 (47.6%) underwent early and 163 (52.4%) underwent delayed surgery. The median surgery interval was 9.0 days. After adjustment, the groups had similar patient and tumor characteristics. In terms of short-term outcomes, there was no difference in hospitalization length or postoperative complications. No deaths were observed. With a median follow-up of 71.0 months, no significant difference was observed between the groups in 5-year overall survival (early vs. delayed surgery: 79.6% vs. 71.3%, P = 0.370) and 5-year disease-free survival (early vs. delayed surgery: 59.1% vs. 60.4%, P = 0.970).
In obstructive left-sided CRC, the time interval between SEMS and radical surgery did not significantly influence short- and long-term outcomes. Therefore, early surgery after SEMS could be suggested if there is no reason to postpone surgery for preoperative medical optimization.
自膨式金属支架（SEMS）通常用于临时解决左侧结直肠癌（CRC）的梗阻，作为择期手术的桥梁。然而，对于支架置入与根治性手术之间的合适时间间隔尚无共识。本研究旨在确定导致短期和长期结果良好的最佳时间间隔。
回顾性分析了 2004 年至 2016 年期间，五家三级转诊医院中因临床成功放置 SEMS 而接受择期根治性手术的梗阻性左侧 CRC 患者的数据。采用逆概率治疗加权倾向评分分析来尽量减少偏差。比较两组患者的术后短期和长期结果：早期手术（8 天内）组和延迟手术（8 天后）组。
311 例患者中，148 例（47.6%）行早期手术，163 例（52.4%）行延迟手术。中位手术间隔为 9.0 天。调整后，两组患者的患者和肿瘤特征相似。在短期结果方面，住院时间和术后并发症无差异。未观察到死亡。中位随访 71.0 个月，两组 5 年总生存率（早期 vs. 延迟手术：79.6% vs. 71.3%，P=0.370）和 5 年无病生存率（早期 vs. 延迟手术：59.1% vs. 60.4%，P=0.970）无显著差异。
在左侧梗阻性 CRC 中，SEMS 与根治性手术之间的时间间隔不会显著影响短期和长期结果。因此，如果没有理由为术前医疗优化而推迟手术，建议在 SEMS 后进行早期手术。
