Objective: This study aimed to evaluate the outcomes of colorectal obstruction patients without distant metastases treated with different strategies. Methods: This retrospectively study included 82 patients who presented in Beijing Chaoyang Hospital from 2010 to 2015 with acute left-sided malignant colorectal obstruction. Patients with distant metastases were excluded. After informed consent, patients were divided into colonic stenting (SEMS group, n=28) , neoadjuvant chemotherapy(NCT group, n=15) or immediate emergency surgery(control group, n=39). Patients who had successful colonic stenting underwent elective surgery 1 to 2 weeks later or underwent neoadjuvant chemotherapy before elective surgery, while the other group had emergency surgery. Short-term data on postoperative mortality, morbidity, length of intensive care and hospital stay were compared. Overall survival and disease-free survival were also analyzed. Results: Patients in the three study arms had similar demographic profiles. The laparoscopic resection of the NCT and SEMS group was higher than that of the control group, the stoma rate was lower, and the differences were statistically significant[73.3% (11/15) , 42.9% (12/28) vs 25.6% (10/39) (P=0.006) and 13.3% (8/15) , 28.6% (8/28) vs 66.7% (26/39) (P<0.001) respectively].Compared with the SEMS and NCT group, the control group had a higher rate of postoperative complications, less of retrieved lymph nodes, longer of intensive care and lower total hospitalization expenses, and the difference was statistically significant[32.1% (9/28) , 13.3% (2/15) vs 59.0% (23/39) (P=0.004) , 21 (16,25) , 23 (19,34) vs 17 (13,25) (P=0.02) , 1.5 (0,3.0) , 1.0 (0,3.0) vs 3.0 (1.0, 4.0) (P=0.028) and 7.3 (2.8,14.1) , 11.1 (6.9,18.5) vs 7.1 (3.3,37.4) (P=0.004) respectively]. The overall and disease-free survival rate of the NCT group were higher than the SEMS group and control group, and the difference was statistically significant[93.3% (14/15) , 57.1% (16/28) vs 61.5% (24/39) (P=0.033) and 86.7% (13/15) , 53.6% (15/28) vs 51.3% (20/39) (P=0.047) respectively]. There was no significant difference among the NCT, SEMS and control group in the rate of systemic recurrence of the[6.7% (1/15) , 25.0% (7/28) vs 28.2% (11/39) (P=0.243) ]. Conclusions: For acute left-sided malignant colorectal obstruction without distant metastases, endoscopic stent placement combined with NCT not only is a bridge to elective operation, but also significantly improves the long-term results.
目的： 评估肠道支架植入术及联合新辅助化疗对无远处转移的急性左侧恶性结直肠梗阻患者的短期及长期预后的影响。 方法： 回顾性分析2010年1月至2015年12月因急性肠梗阻首次于首都医科大学附属北京朝阳医院就诊的结直肠癌患者，排除右半结肠梗阻及有远处转移的患者后，对患者进行至少3年的随访。根据治疗方式不同将患者分为化疗组、支架组及对照组。对照组患者直接行根治切除手术。支架组患者先植入肠道支架减压治疗，待梗阻解除后再择期行根治术。化疗组患者植入支架解除梗阻后，先予CapeOX方案化疗2个周期，再择期行根治术。比较3组间的短期及长期预后。 结果： 共纳入患者82例，对照组39例，支架组28例，化疗组15例。3个研究组的患者具有相似的人口统计学特征。化疗组和支架组的腹腔镜切除率高于对照组、造口率低于对照组，分别为73.3%（11/15）比42.9%（12/28）比25.6%（10/39）（P=0.006）和13.3%（8/15）比28.6%（8/28）比66.7%（26/39）（P<0.001）。对照组与支架组、化疗组相比，术后并发症发生率较高，淋巴结检出量较低，重症监护病房时间较长，但住院总费用较低，分别为59.0%（23/39）比32.1%（9/28）比13.3%（2/15）（P=0.004）、17（13,25）比21（16,25）比23（19,34）（P=0.02）、3.0（1.0，4.0）比1.5（0,3.0）比1.0（0,3.0）（P=0.028）和7.1（3.3,37.4）比7.3（2.8,14.1）比11.1（6.9,18.5）（P=0.004）。化疗组的总生存率和无病生存率均高于支架组和对照组，分别为93.3%（14/15）比57.1%（16/28）比61.5%（24/39）（P=0.033）和86.7%（13/15）比53.6%（15/28）比51.3%（20/39）（P=0.047），而3组间肿瘤3年复发率差异无统计学意义，分别为6.7%（1/15）比25.0%（7/28）比28.2%（11/39）（P=0.243）。 结论： 对合并肠梗阻的无远处转移的左半结肠及直肠癌患者，支架植入联合新辅助化疗不仅可作为手术前的过渡，而且可以显著提高患者的长期生存率。.
Keywords: Antineoplastic protocols; Colorectal neoplasms; Intestinal obstruction; Stent.