Chen Engeng, Chen Li, Zhang Wei, Zhou Wei
Department of Colorectal Surgery, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
Updates Surg. 2025 Apr 7. doi: 10.1007/s13304-025-02187-0.
Left-sided colorectal obstruction represents a formidable challenge in colorectal cancer management, often necessitating urgent intervention. Although self-expanding metal stents (SEMS) may act as a bridge to more controlled, elective surgery, the question remains whether this strategy confers measurable advantages over immediate emergency surgery (ES). We conducted a single-center, retrospective study comparing outcomes in patients with left-sided colorectal obstruction who underwent either SEMS placement followed by elective resection or direct ES. Between January 2018 and August 2023, 189 eligible patients were included. Perioperative variables, stoma formation, operative blood loss, and survival rates were documented. Kaplan-Meier analyses were performed to assess overall and disease-free survival in both groups. Of the 99 patients allocated to the SEMS group, 98 achieved successful stent deployment and 89 (91%) proceeded to elective surgery without stent-specific complications. Compared with the 100 patients in the ES group, the SEMS cohort exhibited significantly lower intraoperative blood loss (p < 0.001) and an increased rate of minimally invasive surgeries (p < 0.001). While all patients in the ES group underwent colostomy, only 80 in the SEMS group required ileostomy, and an additional 9 underwent primary anastomosis without a diversion. Ileostomy closure was completed more frequently (p = 0.002) and required less operative time (p < 0.001) than colostomy closure, resulting in reduced hospitalization. No significant differences in overall survival (p = 0.091) or disease-free survival (p = 0.22) were observed between the two treatment groups. In selected patients with obstructing left-sided colorectal cancers, SEMS placement as a bridge to elective surgery may reduce operative trauma, facilitate minimally invasive procedures, and lessen the burden of stoma formation, all without compromising long-term oncologic outcomes. Careful patient selection and strict procedural vigilance are fundamental to ensuring the safe adoption of this strategy.
左侧结直肠癌梗阻是结直肠癌治疗中一项严峻的挑战，常常需要紧急干预。尽管自膨式金属支架（SEMS）可作为通向更可控的择期手术的桥梁，但问题依然存在，即这种策略是否比直接急诊手术（ES）具有可衡量的优势。我们进行了一项单中心回顾性研究，比较接受SEMS置入后择期切除或直接ES的左侧结直肠癌梗阻患者的结局。在2018年1月至2023年8月期间，纳入了189例符合条件的患者。记录围手术期变量、造口形成、术中失血和生存率。进行Kaplan-Meier分析以评估两组的总生存率和无病生存率。在分配到SEMS组的99例患者中，98例成功置入支架，89例（91%）进行了择期手术，无支架特异性并发症。与ES组的100例患者相比，SEMS队列的术中失血显著更少（p<0.001），微创外科手术率更高（p<0.001）。ES组的所有患者均接受了结肠造口术，而SEMS组仅80例需要回肠造口术，另外9例进行了一期吻合而未行转流。与结肠造口关闭相比，回肠造口关闭完成得更频繁（p=0.002），所需手术时间更短（p<0.001），从而缩短了住院时间。两个治疗组之间在总生存率（p=0.091）或无病生存率（p=0.22）方面未观察到显著差异。在选定的左侧结直肠癌梗阻患者中，SEMS置入作为通向择期手术的桥梁可减少手术创伤，便于进行微创操作，并减轻造口形成的负担，且均不影响长期肿瘤学结局。仔细的患者选择和严格的操作警惕性是确保安全采用该策略的基础。
