Abstract
Objective:To evaluate the safety of preoperative stent insertion and compare the short- and long-term outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer.Methods:The clinical data of 302 patients who underwent surgery for obstructive left-sided colorectal cancer from January 2009 to May 2014 were retrospectively analyzed. They were divided into two groups according to whether to receive stenting for the success rate and complications of stent insertion in colonic lumen by colonoscope, and the number of cases of primary resection and anastomosis, and short-term complications such as incision infection, anastomotic leakage, spleen tear and abdominal abscess as well as mortality and survival rate during hospitalization were compared.Results:The success rate of endoscopic nitinol alloy memorial stent insertion in colonic lumen was 97.62%, and the overall incidence of complications was 14.5%, of which the incidence of serious complications (perforation, stent migration) was 4.76%. The primary anastomosis rate was significantly higher in the stent insertion group (85.71%) than that in the emergency surgery group (36.24%). The overall complication rate in the stent insertion group (14 cases) was significantly lower than that in the emergency surgery group (102 cases). There was no significant difference between survival curves (P>0.05).Conclusion:Preoperative stent insertion in colonic lumen by colonoscope for decompression is an ideal auxiliary method in the treatment of obstructive left-sided colorectal cancer, and may increase primary anastomosis rate, avoid neostomy, reduce short-term complications, and improve the long-term survival compared to emergency surgery.
Highlights
Colorectal cancer is one of the most common digestive malignancies, including colon cancer and rectal cancer
This study summarized the data of 302 patients with left colorectal cancer complicated with acute intestinal obstruction who received treatments with different methods in our hospital from January 2007 to May 2012, which were analyzed as follows
There were 72 patients undergoing primary resection and anastomosis, 7 patients with wide metastasis giving up surgery after stenting, 3 patients receiving selective Hartmann operation and 2 patients with intestinal perforation undergoing emergency Hartmann operation; and emergency surgery group (n=218), in which 79 patients underwent primary resection and anastomosis after emergency decompression and the other 139 patients received emergency Hartmann operation
Summary
Colorectal cancer is one of the most common digestive malignancies, including colon cancer and rectal cancer. About 10%-40% of patients with colorectal cancer may suffer from acute obstruction,[2] mostly being located at the junction of the left colon and rectosigmoid.[3] Besides, 85% of obstruction patients need emergency surgical treatment, the prognosis of which is much worse than that of selective operation.[4] The mortality rate of emergency surgery is 15% to 20%, with a variety of complications as high as 45% to 81%, while the mortality rate of selective operation is only 0.9% to 6%.5. This study summarized the data of 302 patients with left colorectal cancer complicated with acute intestinal obstruction who received treatments with different methods in our hospital from January 2007 to May 2012, which were analyzed as follows
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