结肠支架联合术前化疗治疗急性左半结肠癌梗阻对照研究

Self-expandable metallic stenting followed by pre-operation chemotherapy as a bridge to surgery for acute left-sided obstructive colonic cancer

目的对比分析自膨胀支架置入(SEMS)联合术前化疗治疗急性左半结肠癌恶性梗阻的近期疗效,探讨手术方式和手术时机选择。方法回顾性分析2016年1月至2019年6月首都医科大学附属北京朝阳医院收治的109例急性左半结肠癌梗阻病例的临床资料,比较SEMS联合术前化疗+择期手术(支架化疗组,27例)、SEMS联合择期手术(支架手术组,33例)以及急诊手术(急诊手术组,49例)3种治疗方案的临床疗效。结果支架化疗组、支架手术组与急诊手术组的腹腔镜手术比例(74.1%、42.4%vs.20.4%,P<0.001)、肿瘤近端肠管切除长度[(10.5±4.7)cm、(10.3±4.6)cm vs.(5.0±2.2)cm,P=0.033]以及淋巴结检出数目[(23.7±6.0)枚、(26.0±9.3)枚vs.(17.3±5.9)枚,P=0.037]差异有统计学意义。支架化疗组与支架手术组的消化道造口率(18.5%、21.2%vs.79.6%,P<0.001)和术后感染发生率(14.8%、27.3%vs.46.9%,P=0.012)明显低于急诊手术组。支架化疗组的肿瘤近端10 cm左右结肠管壁厚度小于支架手术组(4 mm vs.9 mm,P<0.001)。支架化疗组的术前等待时间>4周者的肿瘤退缩分级显著优于等待时间≤3周者(P=0.029)。结论与急诊手术比较,SEMS联合术前化疗+择期手术治疗急性左半结肠癌恶性梗阻,实施腹腔镜手术比例更高,消化道造口率和术后并发症发生率明显降低,术前化疗后等待时间>4周可以提高肿瘤退缩程度,但暂无肿瘤降期的证据。

Objective To investigate the surgical procedures and operation timing for self-expandable metallic stenting(SEMS)followed by pre-operation chemotherapy as a bridge to surgery for acute left-sided obstructive colonic cancer.Methods The clinical data of 109 cases of acute left-sided obstructive colonic cancer admitted from January2016 to June 2019 in Beijing Chao-Yang Hospital were analyzed retrospectively.The surgical procedures,operation timing,post-operation complications and tumor regression grading and so on were compared between"SEMS followed by pre-operation chemotherapy as a bridge to surgery(SCS group,27 cases)","SEMS as a bridge to surgery(SS group,33 cases)"and"Emergency surgery(ES group,49 cases)".Results Laparoscopic resection(74.1%,42.4%vs.20.4%,P<0.001),length of bo-wel proximal to the tumor[(10.5±4.7)cm,(10.3±4.6)cm vs.(5.0±2.2)cm,P=0.033]and lymph node(23.7±6.0,26.0±9.3 vs.17.3±5.9,P=0.037)in SCS group and SS group were significantly more than in ES group.Stoma(18.5%,21.2%vs.79.6%,P<0.001)and post-operation infections(14.8%,27.3%vs.46.9%,P=0.012)in SCS group and SS group were less than those in ES group.Thickness of bowel which 10 cm proximal to the tumor in SCS group was significantly less than that in SS group(4 mm vs.9 mm,P<0.001).Tumor regression grading in SCS group whose preoperation intervals that more than 4 weeks was higher than that less than 3 weeks(P=0.029).Conclusion SEMS followed by pre-operation chemotherapy for acute leftsided obstructive colonic cancer treatment makes more laparoscopic resection applied and led less stoma and post-operation complications than emergency surgery.More than 4 weeks delay after pre-operation chemotherapy may lead to better tumor regression grading,while no evidence of degrading on TNM stage.