Ji L, Li S, Zhou J, Xin C, Liu P, Lou Z, Zhang W
Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
Anesthesiology Department, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
Tech Coloproctol. 2024 Dec 20;29(1):30. doi: 10.1007/s10151-024-03051-w.
To investigate the optimal interval between self-expanding metal stent (SEMS) placement and radical surgery in patients with obstructive colorectal cancer.
In this study, a retrospective research design was used to select 125 patients with obstructive colorectal cancer who underwent colonoscopic SEMS placement with subsequent radical surgery between February 2011 and November 2022 at Shanghai Changhai Hospital. In addition, their clinical data and therapeutic efficacy were examined. Grouping: grouping on the basis of the interval of bridge to surgery (BTS). Group A: interval of BTS ≤ 14 days; group B: 14 days < interval of BTS ≤ 21 days; group C1: interval of BTS > 21 days; group C2: interval of BTS > 21 days, excluding patients who received neoadjuvant therapy; group D: patients who received neoadjuvant therapy. Patients were grouped according to their different surgical methods, group E: patients who received open surgery and group F: patients undergoing laparoscopic surgery.
A total of 125 patients were included in this study, the mean age of the patients was 61.34 ± 13.99 years, with the median follow-up time was 39 (25-61) months. Of these, 84 cases (67.2%) underwent open surgery, while 41 cases (32.8%) underwent laparoscopic surgery. Among the cohort, 15 patients received neoadjuvant radiotherapy and chemotherapy after placement of SEMS. There was a significant difference in preoperative hemoglobin levels between group A and both group B and group C1. The laparoscopic surgery rate was significantly higher in group B than in the other two groups (48.57% versus 3.33% and 22.81%, P = 0.038). The 5-year disease-free survival (DFS) of group C1 patients was lower than that in group A and group B (32.4% versus 56.3%, 62.3%, P = 0.038; P = 0.043), whereas there was no statistical difference in the 5-year overall survival (OS) (60.7% versus 62.1%, 69.6%, P = 0.365, P = 0.339). group D showed a higher proportion of open surgery and a higher T-stage (P < 0.05), resulting in a 5-year DFS that was inferior to group A and group B (17.7% versus 56.3%, 62.3%, P = 0.045; P = 0.047). However, there was no significant difference compared with group C2 (17.7% versus 36.9%, P > 0.05). The 5-year OS of group D was not statistically significantly different from that of group A, group B, and group C2 (28.4% versus 62.1%, 69.6%, 73.4%, P = 0.089, P = 0.090, P = 0.183). In addition, no statistically significant differences were identified in 5-year DFS (49.9% versus 37.0%, P = 0.555) or 5-year OS (66.2% versus 62.6%, P = 0.062) between group E and group F CONCLUSIONS: Radical surgery performed 14-21 days apart after SEMS placement has been shown to improve minimally invasive rates and 5-year DFS rates. The addition of neoadjuvant radiotherapy and chemotherapy during the interval does not appear to improve long-term survival, although this conclusion is based on the results of only 15 patients.
探讨梗阻性结直肠癌患者自膨式金属支架（SEMS）置入与根治性手术之间的最佳间隔时间。
本研究采用回顾性研究设计，选取2011年2月至2022年11月期间在上海长海医院接受结肠镜下SEMS置入并随后进行根治性手术的125例梗阻性结直肠癌患者。此外，对他们的临床资料和治疗效果进行了检查。分组：根据桥接手术（BTS）间隔时间进行分组。A组：BTS间隔时间≤14天；B组：14天＜BTS间隔时间≤21天；C1组：BTS间隔时间＞21天；C2组：BTS间隔时间＞21天，不包括接受新辅助治疗的患者；D组：接受新辅助治疗的患者。根据不同手术方式对患者进行分组，E组：接受开放手术的患者，F组：接受腹腔镜手术的患者。
本研究共纳入125例患者，患者的平均年龄为61.34±13.99岁，中位随访时间为39（25 - 61）个月。其中，84例（67.2%）接受了开放手术，41例（32.8%）接受了腹腔镜手术。在该队列中，15例患者在SEMS置入后接受了新辅助放化疗。A组与B组和C1组术前血红蛋白水平存在显著差异。B组的腹腔镜手术率显著高于其他两组（48.57%对3.33%和22.81%，P = 0.038）。C1组患者的5年无病生存率（DFS）低于A组和B组（32.4%对56.3%，62.3%，P = 0.038；P = 0.043），而5年总生存率（OS）无统计学差异（60.7%对62.1%，69.6%，P = 0.365，P = 0.339）。D组开放手术比例较高且T分期较高（P＜0.05），导致5年DFS低于A组和B组（17.7%对56.3%，62.3%，P = 0.045；P = 0.047）。然而，与C2组相比无显著差异（17.7%对36.9%，P＞0.05）。D组的5年OS与A组、B组和C2组相比无统计学差异（28.4%对62.1%，69.6%，73.4%，P = 0.089，P = 0.090，P = 0.183）。此外，E组和F组之间的5年DFS（49.9%对37.0%，P = 0.555）或5年OS（66.2%对62.6%，P = 0.062）无统计学差异。结论：SEMS置入后14 - 21天进行根治性手术已被证明可提高微创率和5年DFS率。尽管这一结论仅基于15例患者的结果，但在此间隔期间添加新辅助放化疗似乎并未改善长期生存率。
