晚期结直肠恶性梗阻的姑息性处理：系统评价和荟萃分析。
Palliative procedures for advanced obstructive colorectal cancer: a systematic review and meta-analysis.
机构信息
Department of Emergency General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
出版信息
Int J Colorectal Dis. 2024 Sep 23;39(1):148. doi: 10.1007/s00384-024-04724-6.
PURPOSE
Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment.
METHODS
PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B).
RESULTS
Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate.
CONCLUSION
Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment.
目的
晚期阻塞性结直肠癌（AOCC）的治疗具有一定难度。在减轻症状的同时，还应考虑提高患者的生活质量和延长生存时间。本研究对比了姑息性自膨式金属支架（SEMS）和手术的疗效，为 AOCC 的治疗提供参考。
方法
检索PubMed、Web of Science、MEDLINE 和 Cochrane Library 中符合纳入标准的研究。采用荟萃分析方法，对比 SEMS 组和手术组患者的术后并发症、生存率等预后指标，并采用网状 Meta 分析比较 SEMS、原发肿瘤切除术（PTR）和造口/旁路（S/B）的预后。
结果
共纳入 21 项研究（1754 例患者）。SEMS 组临床成功率的优势比（OR）为 0.32（95%置信区间[CI] 0.15，0.65）。SEMS 组早期和晚期并发症的 OR 分别为 0.34（95% CI 0.19，0.59）和 2.30（95% CI 1.22，4.36）。SEMS 组 30 天死亡率和造口形成率的 OR 分别为 0.65（95% CI 0.42，1.01）和 0.11（95% CI 0.05，0.22）。SEMS 组的住院时间标准化均数差为-2.08（95% CI-3.56，0.59）。总生存的风险比为 1.24（95% CI 1.08，1.42）。网状 Meta 分析显示，SEMS 组的早期并发症和造口形成率最低，30 天死亡率最低，住院时间最短；PTR 组的临床成功率最高，晚期并发症发生率最低；S/B 组的 30 天死亡率最低。
结论
在 AOCC 的姑息治疗中，SEMS 具有较低的早期并发症发生率、造口形成率和 30 天死亡率，以及较短的住院时间。手术的临床成功率和总生存率较高，晚期并发症发生率较低。选择 AOCC 的治疗方法时，应考虑患者的病情和偏好。
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