Xiao Hui, Ma Hua-Chong
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of Acute Abdominal Surgery, Capital Medical University, Beijing 100020, China.
World J Gastrointest Surg. 2025 Jul 27;17(7):104118. doi: 10.4240/wjgs.v17.i7.104118.
Self-expandable metal stent (SEMS) as a bridge to surgery (BTS) has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction (MCO). However, it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.
To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.
The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively. They underwent colonic stenting as a bridge to elective surgery (BTS group: = 40) or emergency resection (ER group: = 56). Demographic characteristics, stoma rate, laparoscopy rate, postoperative complications, and oncological outcomes were compared between the two groups.
The two groups were comparable with regard to the demographics and tumor characteristics. The stoma rate was 7.5% in the BTS group 48.2% in the ER group ( < 0.05). Primary anastomosis was performed in all patients in the BTS group, and only three patients underwent protective stoma in the BTS group. The BTS group had a significantly higher rate of laparoscopic surgery than the ER group (90% 57.1%, < 0.05), and the major postoperative complication rate was significantly higher in the ER group than in the BTS group (33.9% 15%, = 0.04). According to the Kaplan-Meier survival analysis and log rank test, no significant differences existed in the two groups with regard to the overall survival and disease-free survival.
The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO. SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
自膨式金属支架（SEMS）作为手术桥梁（BTS），在急性左侧恶性结肠梗阻（MCO）的治疗中已成为紧急手术的一种常用替代方法。然而，由于缺乏共识且数据不足，结肠支架作为BTS仍存在争议。
评估SEMS置入后择期切除治疗急性左侧MCO的临床及肿瘤学安全性。
回顾性分析2018年1月至2020年5月我院96例急性左侧MCO患者的数据。他们接受了结肠支架置入作为择期手术的桥梁（BTS组：n = 40）或急诊切除（ER组：n = 56）。比较两组的人口统计学特征、造口率、腹腔镜手术率、术后并发症及肿瘤学结局。
两组在人口统计学和肿瘤特征方面具有可比性。BTS组的造口率为7.5%，ER组为48.2%（P < 0.05）。BTS组所有患者均进行了一期吻合，BTS组仅3例患者进行了预防性造口。BTS组的腹腔镜手术率显著高于ER组（90%对57.1%，P < 0.05），ER组的术后主要并发症发生率显著高于BTS组（33.9%对15%，P = 0.04）。根据Kaplan-Meier生存分析和对数秩检验，两组在总生存和无病生存方面无显著差异。
SEMS作为BTS在急性左侧MCO的治疗中是紧急手术的一种有用替代方法。与紧急手术相比，SEMS置入作为BTS可提供有效且安全的治疗选择。
