Treatment outcome of laparoscopic surgery after self-expandable metallic stent insertion for obstructive colorectal cancer
Treatment outcome of laparoscopic surgery after self-expandable metallic stent insertion for obstructive colorectal cancer
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DOI：
10.1007/s10147-021-01990-0
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发表时间：
2021-07-28
影响因子：
3.3
通讯作者：
Fukunaga, Yosuke
中科院分区：
文献类型：
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作者：
Hiyoshi, Yukiharu;Mukai, Toshiki;Fukunaga, Yosuke
背景我们评估了自膨式金属支架（SEMS）插入后腹腔镜结直肠手术作为梗阻性结直肠癌（CRC）手术过渡（BTS）的技术和肿瘤学安全性。方法一项回顾性单中心研究分析了2012年至2020年在癌症研究所医院进行的II/III/IV期梗阻性CRC患者中SEMS插入后腹腔镜结直肠手术的短期和长期结局。结果66例患者中，包括28例IV期患者，SEMS插入的临床成功率为97%。在腹腔镜手术中，61例患者（92%）进行了初次吻合，2例患者（3%）需要开放转换。9例患者（13%）出现术后并发症;但是，无吻合口瘘或死亡。所有38例II/III期患者和28例IV期患者中的15例（54%）实现了治愈性切除。与II/III期患者相比，IV期患者的手术时间更长，失血量更大;然而，两组之间的开放转换和术后并发症发生率相似。在II/III期患者中，3年无病生存率和3年总生存率[OS]分别为87.1%和89.5%。IV期患者的中位OS为34.9个月，接受R 0切除术的IV期患者的OS显著优于接受R2切除术的患者（P = 0.0011）。结论SEMS置入后行腹腔镜手术治疗II/III期和IV期梗阻性结直肠癌，一期吻合率高，术后无严重并发症，是一种可行的治疗策略。
Background We assessed the technical and oncological safety of self-expandable metallic stent (SEMS) insertion followed by laparoscopic colorectal surgery as a bridge to surgery (BTS) for obstructive colorectal cancer (CRC). Methods A retrospective, single-center study analyzed the short- and long-term outcomes of SEMS insertion followed by laparoscopic colorectal surgery in patients with stage II/III/IV obstructive CRC from 2012 to 2020 at Cancer Institute Hospital. Results In 66 patients, including 28 stage IV patients, the clinical success rates of SEMS insertion were 97%. In laparoscopic surgery, primary anastomosis was performed in 61 patients (92%), and open conversion was required in 2 patients (3%). Postoperative complications were seen in 9 patients (13%); however, there was no anastomotic leakage or mortality. Curative resection was achieved in all 38 stage II/III patients and 15 of 28 (54%) stage IV patients. Stage IV patients had a longer operation time and greater blood loss than stage II/III patients; however, the open conversion and postoperative complication rates were similar between the groups. In stage II/III patients, 3-year disease-free survival and 3-year overall survival [OS] were 87.1 and 89.5%, respectively. The median OS of stage IV patients was 34.9 months, and stage IV patients who underwent R0 resection showed a significantly better OS (P = 0.0011) than those with R2 resection. Conclusion SEMS insertion followed by laparoscopic surgery is a feasible treatment strategy that achieves a high-primary anastomosis rate without severe postoperative complication in not only stage II/III but also stage IV obstructive CRC patients.