Preoperative diagnosis of obstructive colitis in colorectal cancer patients who underwent self-expandable metallic stent insertion as a bridge to surgery
Preoperative diagnosis of obstructive colitis in colorectal cancer patients who underwent self-expandable metallic stent insertion as a bridge to surgery
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DOI：
10.1016/j.asjsur.2022.02.026
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发表时间：
2022-11-16
影响因子：
3.5
通讯作者：
Ishihara, Soichiro
中科院分区：
文献类型：
--
作者：
Emoto, Shigenobu;Yokoyama, Yuichiro;Ishihara, Soichiro
目的：梗阻性结肠炎（OC）是结直肠癌术后吻合口瘘的危险因素。我们的目的是阐明OC的严重程度和临床病理结果之间的关系，并检测OC的预测因素。方法：回顾性分析43例左半结肠癌行结肠切除术后放置自膨式金属内支架的临床资料。OC的术前诊断是通过多种方式（初始计算机断层扫描（CT），术前CT和结肠镜检查）。我们将切除标本中的OC肉眼分为五组（0级：无，1级：轻度[轻度水肿]，2级：中度[重度水肿，发红，糜烂]，3级：重度[溃疡，出血]，4级：非常严重[坏死，穿孔]），并研究术前评估，手术结果和OC严重程度之间的关系。结果：OC ≥ 2级（53.5%）与首次CT检查时重度水肿显著相关。OC与吻合率无明显相关性。2级或以上OC组的覆盖性造口创建率显著较高。两组均未观察到渗漏。结论：初次CT检查对预测OC最有价值。结合多种方法对OC进行术前诊断，确定合适的切除、吻合和覆盖造口的位置是非常重要的。(c)2022年亚洲外科协会和台湾机器人外科协会。Elsevier B. V.的出版服务。这是CC BY-NC-ND许可证（http：//www.example.com licenses/by-nc-nd/4.0/）下的开放获取文章。creativecommons.org/
Purpose: Obstructive colitis (OC) is a risk factor of anastomotic leakage in colorectal cancer resection. We aimed to clarify the relationship between the severity of OC and clinicopathological findings and to detect predictive factors of OC. Methods: We retrospectively reviewed 43 cases of colectomy after self-expandable metallic stent placement for left-sided colorectal cancer. Preoperative diagnosis of OC was made by multiple modalities (initial computed tomography (CT), presurgical CT, and colonoscopy). We classified OC macroscopically in resected specimens into five groups (Grade 0: none, 1: mild [mild edema], 2: moderate [severe edema, redness, erosion], 3: severe [ulceration, bleeding], 4: very severe [necrosis, perforation]), and investigated the relationship between the preoperative assessment, surgical findings and the severity of OC. Results: OC of Grade 2 or more (53.5%) was significantly correlated with severe edema in initial CT. There was no significant correlation between OC and anastomosis rate. The creation of covering stoma was significantly higher in the Grade 2 or more OC group. No leakage was observed in either group. Conclusions: Initial CT may be most useful for prediction of OC. It is important to make a preoperative diagnosis of OC by combining multiple modalities, which enables to determine the appropriate location for resection, anastomosis, and construction of a covering stoma. (c) 2022 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).