中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (04): 424-428.DOI: 10.19538/j.cjps.issn1005-2208.2023.04.12

• 论著 • 上一篇    下一篇

置入可扩张金属支架联合新辅助化疗治疗完全梗阻性左半结肠癌远期疗效分析

李干斌1a,2，于剑锋1b，翟志伟1a，渠    浩1a，魏广辉1a，王燕斌1b，姚健楠1c，韩加刚1a，王振军1a   

  1. 1首都医科大学附属北京朝阳医院 a.普通外科 b.消化内科 c.肿瘤内科，北京 100020；2中国医学科学院北京协和医院基本外科，北京 100005
  • 出版日期:2023-04-01 发布日期:2023-04-18

  • Online:2023-04-01 Published:2023-04-18

摘要： 目的    探讨置入可扩张金属支架联合新辅助化疗治疗完全梗阻性左半结肠癌的远期疗效。方法    回顾性分析2014年1月至2018年1月首都医科大学附属北京朝阳医院普通外科收治的90例完全梗阻性左半结肠癌病人的临床资料，根据治疗策略不同，分为急诊手术组（急诊行根治性切除肿瘤，31例）、支架-手术组（置入支架择期再行根治性手术，34例）和支架-化疗-手术组（置入支架后行新辅助治疗，择期行根治性手术，25例）。主要结局指标是局部复发率和远处转移发生率、3年总体生存率和无病生存率。Kaplan-Meier法绘制生存曲线，Log-rank检验比较组间生存差异。 结果    中位随访时间为42.5（6~84）个月，所有病人均获随访。支架-化疗-手术组的脉管浸润发生率（20.0%）和神经侵犯发生率（24.0%）均低于急诊手术组（48.3%、51.7%）和支架-手术组（44.2%、32.3%），差异有统计学意义（P均<0.05）；淋巴结清扫总数高于急诊手术组和支架-手术组［（25.3±8.7）枚 vs. （16.9±6.1）枚 vs. （21.8±10.5）枚，P=0.002］，但3组间阳性淋巴结检出数差异无统计学意义（P>0.05）。急诊手术组、支架-手术组和支架-化疗-手术组局部复发率分别为12.9%（4/31）、8.8%（3/34）和4.0%（1/25），差异无统计学意义（P>0.05）；支架-化疗-手术组远处转移发生率明显低于支架-手术组（8.0% vs. 26.5%，P=0.023）。支架-化疗-手术组术后复发和转移时间均晚于急诊手术组和支架-手术组。支架-化疗-手术组病人3年总体生存率高于急诊手术组（94.7% vs. 68.1%，P=0.034）和支架-手术组（94.7% vs. 68.7%，P=0.039），而3年无病生存率差异无统计学意义（P>0.05）。结论    置入可扩张金属支架联合新辅助化疗可明显降低完全梗阻性左半结肠癌病人的远处转移发生率，改善远期生存预后。

关键词: 可扩张金属支架, 新辅助化疗, 完全梗阻性左半结肠癌, 远期疗效

Abstract: The long-term survival outcomes of self-expanding metallic stent followed by neoadjuvant chemotherapy for patients with acute obstructing left-sided colon cancer        LI Gan-bin*, YU Jian-feng, ZHAI Zhi-wei, et al. *Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China；Department of General Surgery，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences，Beijing 100730，China
Corresponding authors: HAN Jia-gang, E-mail: hjg211@163.com; WANG Zhen-jun, E-mail: wang3zj@sohu.com
LI Gan-bin and YU Jian-feng are the first authors who contributed equally to the article
Abstract    Objective    To evaluate the long-term survival outcomes of self-expanding metallic stent followed by neoadjuvant chemotherapy for the management of acute obstructing left-sided colon cancer. Methods    The clinical characteristics of a total of 90 consecutive patients diagnosed with acute obstructing left-sided colon cancer admitted into the General Surgery Department of Beijing Chaoyang Hospital, affiliated to Capital Medical University were retrospectively collected from January 2014 to January 2018. According to treatment strategies, patients were divided into emergent surgery group (ES, 31 patients), self-expanding metallic stent group (SEMS, 34 patients) and SEMS followed by neoadjuvant chemotherapy group (SEMS+NAC, 25 patients). The primary endpoints were local recurrence and distant metastasis rates and 3-year overall survival and disease-free survival. Kaplan-Meier curve and log-rank test were used for comparison. Results    The follow-up was end up to October 2021 and the median follow-up was 42.5 (6~84) months. The lymph vascular invasion (20.0% vs. 48.3% vs. 44.2%, P=0.028) and peripheral nerve invasion rates (24.0% vs. 51.7%. vs. 32.3%, P=0.035) were significantly lower in SEMS+NAC group than that in ES and SMES group. Besides, the total harvested lymph nodes was also higher in SEMS+NAC group (25.3±8.7 vs. 16.9±6.1 vs. 21.8±10), though no significant difference was observed in terms of positive nodes. The rates of local recurrence were (12.9% vs. 8.8% vs. 4.0%, P>0.05) and the rates of distant metastasis were (19.4% vs. 26.5% vs. 8.0%) in ES, SEMS and SEMS+NAC group respectively, the metastasis rate was significantly lower in SEMS+NAC than that in SEMS group (8.0% vs. 26.5%, P=0.023). Patients in SEMS+NAC group experienced longer recurrence- and metastasis-free survival time than that in ES and SEMS group. The 3-year OS was significantly higher in SEMS+NAC group than that in ES (94.7% vs. 68.1%, P=0.034) and SEMS (94.7% vs. 68.7%, P=0.039) group, while no significant difference in term of DFS existed among groups. Conclusion    SEMS followed by neoadjuvant chemotherapy is an effective approach for the management of acute obstructing left-sided colon cancer with a significantly reduced distant metastasis rate and improved OS.

Key words: self-expanding metallic stents, neoadjuvant chemotherapy, acute obstructing left-sided colon cancer, long-term outcomes