Sato Kentaro, Fukunaga Yosuke, Takamatsu Manabu, Noguchi Tatsuki, Sakamoto Takashi, Matsui Shimpei, Mukai Toshiki, Yamaguchi Tomohiro, Akiyoshi Takashi
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):41-51. doi: 10.23922/jarc.2024-076. eCollection 2025.
This study aimed to evaluate the safety and long-term outcomes of a one-stage resection and anastomosis approach without preoperative decompression in patients with left-sided incomplete obstructive colorectal cancer.
We conducted a retrospective analysis of 571 patients diagnosed with pT3-4NanyM0 left-sided colorectal cancer who underwent radical resection and primary anastomosis without preoperative decompression or a diverting stoma from April 2012 to December 2019. Of these, 97 (17%) patients presented with incomplete obstruction, while 474 (83%) had no obstruction. Incomplete obstruction was characterized by the inability of a small-caliber endoscope to pass through the tumor without necessitating emergency surgery or decompression due to bowel obstruction. We compared perioperative short-term outcomes, as well as the 5-year overall survival rate and the 5-year relapse-free survival rate between the two groups.
Patients in the incomplete obstruction group experienced significantly longer median intervals between admission and surgery (6 vs. 2 days, P<0.001), higher complication rates (25.8% vs. 15%, P=0.016), and longer median postoperative hospital stays (10 vs. 9 days, P=0.002). However, the rates of anastomotic leakage (2.1% vs. 2.3%, P=1), the 5-year overall survival (91.5% vs. 93.7%, P=0.436), and the 5-year relapse-free survival (80.2% vs. 85.6%, P=0.195) were comparable between the groups.
The outcomes regarding anastomotic leakage and long-term survival for one-stage resection and anastomosis without preoperative decompression in cases of incomplete obstructive colorectal cancer are promising. This management strategy appears feasible and safe with appropriate preoperative bowel preparation.
本研究旨在评估左侧不完全梗阻性结直肠癌患者采用一期切除吻合术且不进行术前减压的安全性和长期预后。
我们对2012年4月至2019年12月期间571例诊断为pT3 - 4NanyM0左侧结直肠癌且接受根治性切除及一期吻合术、未进行术前减压或造口分流的患者进行了回顾性分析。其中，97例（17%）患者存在不完全梗阻，474例（83%）无梗阻。不完全梗阻的特征是小口径内镜无法通过肿瘤，且无需因肠梗阻进行急诊手术或减压。我们比较了两组患者的围手术期短期预后、5年总生存率和5年无复发生存率。
不完全梗阻组患者入院至手术的中位间隔时间显著更长（6天对2天，P<0.001），并发症发生率更高（25.8%对15%，P = 0.016），术后中位住院时间更长（10天对9天，P = 0.002）。然而，两组间吻合口漏发生率（2.1%对2.3%，P = 1）、5年总生存率（91.5%对93.7%，P = 0.436）和5年无复发生存率（80.2%对85.6%，P = 0.195）相当。
对于不完全梗阻性结直肠癌患者，不进行术前减压的一期切除吻合术在吻合口漏和长期生存方面的预后良好。在进行适当的术前肠道准备后，这种治疗策略似乎可行且安全。
