Is Stenting as "a Bridge to Surgery" an Oncologically Safe Strategy for the Management of Acute, Left-Sided, Malignant, Colonic Obstruction? A Comparative Study With a Propensity Score Analysis
Is Stenting as "a Bridge to Surgery" an Oncologically Safe Strategy for the Management of Acute, Left-Sided, Malignant, Colonic Obstruction? A Comparative Study With a Propensity Score Analysis
复制标题
DOI：
10.1097/sla.0b013e31827e30ce
复制
发表时间：
2013-07-01
影响因子：
9
通讯作者：
Regimbeau, Jean-Marc
中科院分区：
文献类型：
--
作者：
Sabbagh, Charles;Browet, Francois;Regimbeau, Jean-Marc
目的与背景：自膨胀金属支架（SEMS）植入术被认为是左侧恶性结肠梗阻（LMCO）急诊手术的一种有希望的替代方法。然而，关于SEMS作为“手术的桥梁”的长期影响的文献是有限和矛盾的。方法：从1998年1月至2011年6月，我们回顾性分析了有治疗目的的LMCO手术患者。主要结局标准是总生存期。短期次要终点包括技术成功率和总成功率，长期次要终点包括5年总生存期、5年癌症特异性死亡率、5年无病生存期、复发率和平均复发时间。在意向治疗的基础上对接受SEMS治疗的患者进行分析。在使用倾向评分来纠正选择偏差后，对总生存率进行分析。结果：SEMS组48例，单纯手术组39例。在总体人群中，SEMS组的总生存率（P = 0.001）和5年总生存率（P = 0.0003）显著低于单纯手术组，SEMS组的5年癌症特异性死亡率显著高于单纯手术组（分别为48%和21% (P = 0.02)）。单纯手术组的5年无病生存率、复发率和平均复发时间更好（无统计学意义）。对于入院时没有转移或穿孔的患者，SEMS组的总生存率（P = 0.003）和5年总生存率（分别为30%和67%，P = 0.001）显著低于单纯手术组。结论：我们的研究结果表明，与立即手术相比，植入SEMS的LMCO患者的总生存率更低。
Objective and Background: Self-expanding metallic stent (SEMS) insertion has been suggested as a promising alternative to emergency surgery for left-sided malignant colonic obstruction (LMCO). However, the literature on the long-term impact of SEMS as "a bridge to surgery" is limited and contradictory.Methods: From January 1998 to June 2011, we retrospectively identified patients operated on for LMCO with curative intent. The primary outcome criterion was overall survival. Short-term secondary endpoints included the technical success rate and overall success rate and long-term secondary endpoints included 5-year overall survival, 5-year cancer-specific mortality, 5-year disease-free survival, the recurrence rate, and mean time to recurrence. Patients treated with SEMS were analyzed on an intention-to-treat basis. Overall survival was analyzed after using a propensity score to correct for selection bias.Results: There were 48 patients in the SEMS group and 39 in the surgery-only group. In the overall population, overall survival (P = 0.001) and 5-year overall survival (P = 0.0003) were significantly lower in the SEMS group than in the surgery-only group, and 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively (P = 0.02)). Five-year disease-free survival, the recurrence rate, and the mean time to recurrence were better in the surgery-only group (not significant). For patients with no metastases or perforations at hospital admission, overall survival (P = 0.003) and 5-year overall survival (30% vs 67%, respectively, P = 0.001) were significantly lower in the SEMS group than in the surgery-only group.Conclusions: Our study results suggest worse overall survival of patients with LMCO with SEMS insertion compared with immediate surgery.