Stenting as a Bridge to Curative Surgery for Obstructive Colorectal Cancer: A Single-center Experience

金屬支架作為阻塞性惡性結腸直腸癌銜接根除性手術：單一醫院經驗分享

陳俊宇(Jun-Yu Chen) ； 顏旭亨(Hsu-Heng Yen) ； 黃玄遠(Xuan-Yuan Huang) ； 陳志誠(Zhi-Cheng Chen) ； 王愷晟(Kai-Chen Wang) ； 黃燈明(Ting-Ming Huang) ； 張譽耀(Yu-Yao Chang)

《中華民國大腸直腸外科醫學會雜誌》 29卷3期 (2018/09) Pp. 133-138

https://doi.org/10.6312/SCRSTW.201809_29(3).10709

摘要

Purpose. The aim of this study was to assess the effectiveness of colonic stents used as a bridge to surgery. Methods. A retrospective chart review of 24 patients who underwent self-expanding metallic stent placement as a bridge to curative surgery for obstructive colorectal cancer between April 2013 and December 2016 at Changhua Christian Hospital was conducted. Results. The technical success rate was 92% and the clinical success rate was 88%. Stent-related complications occurred in 12% of patients and included 1 case of migration (4%), 1 case of continued occlusion (4%), and 1 case of perforation (4%). The patients whose occlusion and perforation did not resolve underwent immediate open curative surgery with loop colostomy. The median time to surgery after stentingwas 16 ± 8 days. All clinically successful cases underwent laparoscopic curative surgery without fecal diversion. No mortalities or anastomotic leakages occurred within 30 days of the procedure. Conclusion. Colonic stenting as a bridge to surgery provides surgical advantages, with a fair surgical success rate and a low overall stoma rate, and without a high risk of anastomotic leakage or intra-abdominal abscess. However, the oncologic outcomes require further evaluation.

關鍵字

Self-expanding metallic stent ； Bridge to curative surgery ； Malignant colorectal obstruction

並列摘要

目的：評估自擴張金屬支架放置對阻塞性惡性結腸直腸癌銜接根除性手術的安全性和有效性。方法：自2013年4月至2016年12月24名惡性結腸直腸癌阻塞患者接受自擴張金屬支架放置後進行根除性手術的回顧性研究。結果：技術和臨床成功率分別為92%和88%。與支架置放相關的併發症共12%，包括穿孔（4%），支架移位（4%）及再阻塞（4%）。再阻塞與穿孔的病人接受立即傳統剖腹腫 瘤根除手術併施作人工肛門。支架置放後平均約16 ± 8天進行根除性手術。所有臨床成功的患者皆順利的接受腹腔鏡根除手術，無須人工肛門，也無任何手術後30天內相關併發症或死亡。結論：自擴張金屬支架作為阻塞性惡性結腸直腸癌銜接根除性手術是有功效和安全的， 唯腫瘤相關預後還需進一步評估。

並列關鍵字

自擴張金屬支架 ； 銜接根除性手術 ； 惡性結腸直腸阻塞

參考文獻

Park SJ, Lee KY, Kwon SH, Lee SH. Stenting as a bridge to surgery for obstructive colon cancer: does it have surgical merit or oncologic demerit? Ann Surg Oncol 2016;23:842-8.

Bayraktar B, Ozemir IA, Kefeli U, Demiral G, Sagiroğlu J, Bayraktar O, Adali G, Ozcelik A, Tortum OB. Colorectal stenting for palliation and as a bridge to surgery: a 5-year follow-up study. World J Gastroenterol 2015;21:9373-9.

Harilingam MR, Khushal A, Aikoye A. Self-expanding metal stenting for obstructing left colon cancer: a district hospital experience. Indian J Gastroenterol 2016;35:305-9.

Horesh N, Dux JY, Nadler M, Lang A, Zmora O, Shacham-Shmueli E, Gutman M, Shapiro R. Stenting in malignant colonic obstruction--is it a real therapeutic option? Int J Colorectal Dis 2016;31:131-5.

Harris GJ, Senagore AJ, Lavery IC, Fazio VW. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg 2001;181:499-506.