A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients

被引：83

作者：

Saito, Shuji ^{[1
]}

Yoshida, Shuntaro ^{[2
]}

Isayama, Hiroyuki ^{[3
]}

Matsuzawa, Takeaki ^{[4
]}

Kuwai, Toshio ^{[5
,6
]}

Maetani, Iruru ^{[7
]}

Shimada, Mamoru ^{[8
]}

Yamada, Tomonori ^{[9
]}

Tomita, Masafumi ^{[10
]}

Koizumi, Koichi ^{[11
]}

Hirata, Nobuto ^{[12
]}

Kanazawa, Hideki ^{[13
]}

Enomoto, Toshiyuki ^{[14
]}

Sekido, Hitoshi ^{[15
]}

Saida, Yoshihisa ^{[14
]}

机构：

[1] Yokohama Shin Midori Gen Hosp, Div Surg, Gastrointestinal Ctr, Midori Ku, 1726-7 Tokaichiba Cho, Yokohama, Kanagawa 2260025, Japan

[2] Univ Tokyo, Grad Sch Med, Dept Endoscopy & Endoscop Surg, Tokyo, Japan

[3] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[4] Saitama Med Univ, Dept Digest Tract & Gen Surg, Saitama Med Ctr, Moroyama, Saitama, Japan

[5] Natl Hosp Org, Dept Gastroenterol, Kure Med Ctr, Kure, Japan

[6] Chugoku Canc Ctr, Kure, Japan

[7] Toho Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Ohashi Med Ctr, Tokyo, Japan

[8] Moriguchi Keijinkai Hosp, Dept Surg, Moriguchi, Osaka, Japan

[9] Japanese Red Cross Nagoya Daini Hosp, Dept Gastroenterol, Nagoya, Aichi, Japan

[10] Kishiwada Tokushukai Hosp, Dept Surg, Kishiwada, Japan

[11] Komagome Hosp, Dept Gastroenterol, Tokyo Metropolitan Canc & Infect Dis Ctr, Tokyo, Japan

[12] Kameda Med Ctr, Dept Gastroenterol, Kamogawa, Japan

[13] Natl Hosp Org, Dept Surg, Sagamihara Hosp, Sagamihara, Kanagawa, Japan

[14] Toho Univ, Ohashi Med Ctr, Dept Surg, Tokyo, Japan

[15] Natl Hosp Org, Dept Surg, Yokohama Med Ctr, Yokohama, Kanagawa, Japan

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2016年 / 30卷 / 09期

关键词：

Colon and rectal cancer; Intestinal obstruction; Self-expandable metallic stent; Bridge to surgery; Multicenter study; Prospective cohort study; TUMOR-CELL DISSEMINATION; LARGE-BOWEL OBSTRUCTION; EMERGENCY-SURGERY; COLONIC OBSTRUCTION; CANCER; MANAGEMENT; METAANALYSIS; EXPERIENCE; ENDOSCOPY; SOCIETY;

D O I：

10.1007/s00464-015-4709-5

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Endoscopic stenting with a self-expandable metallic stent (SEMS) is a widely accepted procedure for malignant colonic obstruction. The Colonic Stent Safe Procedure Research Group conducted the present prospective feasibility study. Our objectives were to estimate the safety and feasibility of SEMS placement as a bridge to surgery (BTS) for malignant colorectal obstruction. We conducted a prospective, observational, single-arm, multicenter clinical trial from March 2012 to October 2013. Each patient was treated with an uncovered WallFlex enteral colonic stent. Patients were followed up until discharge after surgery. A total of 518 consecutive patients were enrolled in this study. The cohort intended for BTS consisted of 312 patients (61 %), and the stent could be released in 305 patients. Technical and clinical success rates were 98 and 92 %, respectively. Elective surgery was performed in 297 patients, and emergency surgery was performed in eight patients for the treatment of complications. The overall preoperative complication rate was 7.2 %. Major complications, including perforation, occurred in 1.6 %, persistent colonic obstruction occurred in 1.0 %, and stent migration occurred in 1.3 % patients. The median time from SEMS to surgery was 16 days. Silent perforations were observed in 1.3 %. Open and laparoscopic surgery was performed in 121 and 184 patients, respectively. The tumor could be resected in 297 patients. The primary anastomosis rate was 92 %. The rate of anastomotic leakage was 4 %, and the overall stoma creation rate was 10 %. The median duration of hospitalization following surgery was 12 days. Overall postoperative morbidity and mortality rates were 16 and 0.7 %, respectively. This largest, multicenter, prospective study demonstrates the feasibility of SEMS placement as a BTS for malignant colorectal obstruction. SEMS serves as a safe and effective BTS with acceptable stoma creation and complication rates in patients with acute malignant colonic obstruction.

引用

页码：3976 / 3986

页数：11

共 43 条

[1]

Adler DG, 2002, AM J GASTROENTEROL, V97, P72

[2] Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer [J].