Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan.
Surg Today. 2024 Sep;54(9):1093-1103. doi: 10.1007/s00595-024-02818-w. Epub 2024 Mar 25.
Self-expandable metallic stent (SEMS) placement is widely used as a bridge to surgery (BTS) procedure for obstructive colorectal cancer. However, evidence regarding the optimal interval between SEMS placement and elective surgery is lacking.
We retrospectively collected data from patients with BTS between January 2013 and October 2021. Inverse probability treatment-weighted propensity score analyses were used to compare short- and long-term outcomes between the short-interval (SI) and long-interval (LI) groups, using a cutoff of 20 days.
In total, 138 patients were enrolled in this study (SI group, n = 63; LI group, n = 75). In the matched cohort, the patients' backgrounds were well balanced. The incidence of Clavien-Dindo grade ≥ II postoperative complications was not significantly different between the SI and LI groups (19.0% vs. 14.0%, P = 0.47). There were no significant differences between the SI and LI groups in the 3-year recurrence-free survival (68.0% vs. 76.4%, P = 0.73) or 3-year overall survival rates (86.0% vs. 90.6%, P = 0.72).
A longer interval did not deteriorate the oncological outcomes. Individual perioperative management with an appropriate interval to improve the patient's condition is required to ensure safe surgery.
自膨式金属支架（SEMS）置入术被广泛用作结直肠恶性梗阻患者的外科手术桥接（BTS）治疗方法。然而，对于 SEMS 置入与择期手术之间的最佳间隔时间，目前尚无相关证据。
我们回顾性收集了 2013 年 1 月至 2021 年 10 月期间接受 BTS 的患者数据。采用逆概率治疗加权倾向评分分析，将 20 天作为时间间隔的截断值，比较短间隔（SI）和长间隔（LI）组之间的短期和长期结局。
本研究共纳入 138 例患者（SI 组 63 例，LI 组 75 例）。在匹配队列中，患者背景得到了很好的平衡。两组术后并发症发生率（Clavien-Dindo 分级≥Ⅱ级）无显著差异（19.0% vs. 14.0%，P=0.47）。两组 3 年无复发生存率（68.0% vs. 76.4%，P=0.73）和 3 年总生存率（86.0% vs. 90.6%，P=0.72）也无显著差异。
更长的间隔时间不会降低肿瘤学结局。需要根据患者情况个体化围手术期管理，以确保安全手术。
