Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer
Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer
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DOI：
10.1007/s00268-011-1139-y
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发表时间：
2011-08-01
影响因子：
2.6
通讯作者：
Navarro, S.
中科院分区：
文献类型：
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作者：
Alcantara, M.;Serra-Aracil, X.;Navarro, S.
背景本研究的主要目的是比较行术中结肠灌洗（IOCL）并一期吻合术的患者与行梗阻性左半结肠癌（OLCC.Methods）预定手术前支架置入术的患者的短期结果和长期结局。患者分为两组：支架和延期手术（组1）和紧急IOCL（组2）。人口统计学变量，风险预测模型，术后发病率和死亡率，分期，并发症，由于支架置入，手术时间，临床随访，医疗费用，随访生存recorded.Results 28例患者（15组1和13组1）。在第2组中检测到过度发病率后，暂停研究。两组在临床和人口统计学方面是同质的。第1组的总体发病率为2/15（13.3%），而第2组为7/13（53.8%）（p = 0.042）。第1组15例患者中无吻合口裂开，而第2组4/13例（30.7%）（p = 0.035）。第1组2例（13.3%）患者和第2组6例（46.1%）患者检测到手术部位感染（p = 0.096）。术后住院时间为8天（IQR 3，第1组）和10天（IQR 10，第2组）（p = 0.05）。平均随访时间为37.6个月（SD = 16.08），各组之间的生存率无差异。结论在我们的设置中，使用支架和预定的手术比IOCL更安全，并与较低的发病率，较短的住院时间，同样良好的长期生存。
Background The main aim of this study was to compare short-term results and long-term outcomes of patients who underwent intraoperative colonic lavage (IOCL) with primary anastomosis with those who had stent placement prior to scheduled surgery for obstructive left-sided colonic cancer (OLCC).Methods We conducted a prospective, controlled, randomized study of patients diagnosed with OLCC. Patients were divided into two groups: stent and deferred surgery (group 1) and emergency IOCL (group 2). Demographic variables, risk prediction models, postoperative morbidity and mortality, staging, complications due to stent placement, surgical time, clinical follow-up, health costs, and follow-up of survival were recorded.Results Twenty-eight patients (15 group 1 and 13 group 1) were enrolled. The study was suspended upon detecting excess morbidity in group 2. The two groups were homogeneous in clinical and demographic terms. Overall morbidity in group 1 was 2/15 (13.3%) compared with 7/13 (53.8%) in group 2 (p = 0.042). None of the 15 patients in group 1 presented anastomotic dehiscence compared with 4/13 (30.7%) in group 2 (p = 0.035). Surgical site infection was detected in 2 (13.3%) patients in group 1 and in 6 (46.1%) in group 2 (p = 0.096). Postoperative stay was 8 days (IQR 3, group 1) and 10 days (IQR 10, group 2) (p = 0.05). The mean follow-up period was 37.6 months (SD = 16.08) with no differences in survival between the groups.Conclusion In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long-term survival.