Long-term outcomes after stenting as a ＂bridge to surgery＂for the management of acute obstruction secondary tocolorectal cancer

• 来源期刊: 世界胃肠肿瘤学杂志：英文版（电子版）
• 学科: 医学
• 关键词: Self-expanding metallic stent COLORECTALCANCER OBSTRUCTIVE COLORECTAL CANCER COLORECTAL cancerchemotherapy COLORECTAL CANCER surgery
• 年，卷（期）: 2016,（1）
• 页码范围: 105-112
• 页数: 8页
• 分类号: R

摘要

Obstructive symptoms are present in 8% of cases atthe time of initial diagnosis in cases of colorectal cancer.Emergency surgery has been classically considered thetreatment of choice in these patients. However, in themajority of studies, emergency colorectal surgery isburdened with higher morbidity and mortality rates thanelective surgery, and many patients require temporalcolostomy which deteriorates their quality of life andbecomes permanent in 10%-40% of cases. The aim ofstenting by-pass to surgery is to transform emergencysurgery into elective surgery in order to improve surgicalresults, obtain an accurate tumoral staging and detectionof synchronous lesions, stabilization of comorbidities andperformance of laparoscopic surgery. Immediate resultswere more favourable in patients who were stentedconcerning primary anastomosis, permanent stoma,wound infection and overall morbidity, having the highersurgical risk patients the greater benefit. However, somefindings laid out the possible implication of stenting inlong-term results of oncologic treatment. Perforationafter stenting is related to tumoral recurrence. In studieswith perforation rates above 8%, higher recurrencesrates in young patients and lower disease free survivalhave been shown. On the other hand, after stentingthe number of removed lymph nodes in the surgicalspecimen is larger, patients can receive adjuvant chemotherapyearlier and in a greater percentage andthe number of patients who can be surgically treatedwith laparoscopic surgery is larger. Finally, there are noconsistent studies able to demonstrate that one strategyis superior to the other in terms of oncologic benefits. Atpresent, it would seem wise to assume a higher initialcomplication rate in young patients without relevantcomorbidities and to accept the risk of local recurrencein old patients （〉 70 years） or with high surgical risk （ASAⅢ/Ⅳ）.