Self-expandable metallic stent as a bridge to elective surgery versus emergency surgery for acute malignant colorectal obstruction.

Autor: Li ZX; Department of Gastrointestinal Surgery, The First Hospital of Putian, Fu Jian, 351100, China., Wu XH; Department of General Surgery, The First Hospital of Nan Ping, Fu Jian, 353000, China., Wu HY; Department of Pathology, The First Hospital of Putian, Fu Jian, 351100, China., Chang WJ; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Chang XJ; Center for Therapeutic Research of Hepatocarcinoma, Beijing 302 Hospital, Beijing, 100000, China., Yi T; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Shi Q; Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Chen JW; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Feng QY; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Zhu DX; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China., Wei Y; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. wei.ye@zs-hospital.sh.cn., Zhong YS; Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. zhong.yunshi@zs-hospital.sh.cn., Xu JM; Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2016 Mar; Vol. 31 (3), pp. 561-70. Date of Electronic Publication: 2015 Dec 23.
DOI: 10.1007/s00384-015-2476-3
Abstrakt: Backgroud: The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.
Methods: From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.
Results: The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P < 0.001; 8.00 ± 3.97 vs. 12.59 ± 9.07 days, P = 0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P < 0.001; 16.7 vs. 37.3%, P = 0.003). Kaplan-Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81).
Conclusions: Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.
Databáze: MEDLINE
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