Hiratsuka Takahiro, Akagi Tomonori, Shiroshita Hidefumi, Shiromizu Akio, Amano Shota, Kawano Yoko, Kono Yohei, Ninomiya Shigeo, Shibara Tomotaka, Ueda Yoshitake, Sumida Yorinobu, Saito Shuji, Etoh Tsuyoshi, Da Tsutomu, Inomata Masafumi
Department of Comprehensive Surgery for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan.
Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Surg Endosc. 2024 Dec;38(12):7319-7328. doi: 10.1007/s00464-024-11324-6. Epub 2024 Oct 15.
Although the short-term outcomes of bridge-to-surgery (BTS) procedures using self-expandable metal stents are favorable, concerns remain regarding worsened prognosis due to tissue injury in the tumor area. Herein, we describe a newly developed covered stent, the Kawasumi Jabara colonic stent™, designed to reduce tissue damage/injury associated with stent-related complications in BTS procedures. This study aimed to evaluate the efficacy and safety of the Kawasumi Jabara colonic stent as a BTS for obstructive colorectal cancer (OCC).
This multicenter retrospective observational study included 44 OCC patients who underwent BTS with stents at four facilities between September 2020 and November 2022. The groups of patients receiving the Kawasumi Jabara and non-covered colonic stents were designated Groups C and NC, respectively. Treatment outcomes related to stent placement and surgery were compared using propensity score matching (PSM) analysis.
Groups NC and C (n = 34 and 10, respectively) showed no significant differences in sex, age, tumor location, histological type, Colorectal Obstruction Scoring System (CROSS) score, or cStage; however, the stent placement duration was shorter in Group C. No significant differences were found in terms of the technical and clinical success rates for stent placement. Stent dislocation was observed in 0 and 2 cases in Groups C and NC, respectively. PSM analysis between eight cases, each from Groups C and NC, revealed no significant differences in stent-related or surgical outcomes between the groups. However, regarding the gross injury score in the resected specimens, Group C had a lower score than Group NC (1.8 vs. 5.5), and the proportion of pathological tissue injury involving deeper layers was also lower in Group C (37.5% vs. 100%).
Compared to conventional non-covered stents, the Kawasumi Jabara colonic stent™ demonstrated favorable safety during stent insertion, retention, and surgery, with only mild tissue injury.
尽管使用自膨式金属支架进行桥接手术（BTS）的短期效果良好，但由于肿瘤区域的组织损伤导致预后恶化的问题仍然存在。在此，我们描述一种新开发的覆膜支架——河合雅巴拉结肠支架™，旨在减少BTS手术中与支架相关并发症相关的组织损伤。本研究旨在评估河合雅巴拉结肠支架作为阻塞性结直肠癌（OCC）的BTS的疗效和安全性。
这项多中心回顾性观察研究纳入了2020年9月至2022年11月期间在四个机构接受BTS支架置入的44例OCC患者。接受河合雅巴拉结肠支架和非覆膜结肠支架的患者组分别指定为C组和NC组。使用倾向评分匹配（PSM）分析比较与支架置入和手术相关的治疗结果。
NC组和C组（分别为n = 34和10）在性别、年龄、肿瘤位置、组织学类型、结直肠梗阻评分系统（CROSS）评分或c期方面无显著差异；然而，C组的支架置入持续时间较短。在支架置入的技术成功率和临床成功率方面未发现显著差异。C组和NC组分别有0例和2例观察到支架移位。对C组和NC组各8例进行PSM分析，结果显示两组之间在支架相关或手术结果方面无显著差异。然而，关于切除标本中的大体损伤评分，C组低于NC组（1.8对5.5），C组涉及更深层的病理组织损伤比例也较低（37.5%对100%）。
与传统的非覆膜支架相比，河合雅巴拉结肠支架™在支架插入、留置和手术期间表现出良好的安全性，仅造成轻度组织损伤。
