Clinical research of the surgical timing for resectable colorectal cancer complicated with obstructions after implantation of SEMS / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To compare the clinical outcomes of endoscopic intestinal stenting combined with elective surgery and emergency surgery at the same time for resectable left colon cancer or rectal cancer with intestinal obstruction and to explore the best time for reoperation after stent implantation. METHODS: The clinical data of 82 cases who underwent endoscopic intestinal stenting in the First Affiliated Hospital of China Medical University for the treatment of left colon cancer and rectal cancer with intestinal obstruction from March 2014 to September 2018 were analyzed retrospectively. Treatments were defined as effective only if primary anastomosis was received without a stoma,and those clinical outcomes were analyzed by receiver operator characteristic(ROC)curve. Another 44 patients diagnosed with colorectal cancer complicated with intestinal obstruction underwent emergency surgery during the same period were the control group. The differences in the first-stage surgical anastomosis rate,average operation time,total hospitalization time,total hospitalization expenses,and postoperative complications between two groups were compared.RESULTS: The area under the ROC curve(AUC)was 0.693 with a certain degree of accuracy(P<0.05). Compared to those within 8 days,the rate of primary anastomosis was significantly higher in those received elective surgery over 8 days,the average operation time was significantly decreased,and the ICU utilization rate was also significantly decreased(P<0.05).Compared with the emergency operation group,the stent group had a significantly higher rate of primary anastomosis,and the average operation time was significantly lower. The postoperative ICU utilization rate and the incidence of diarrhea were significantly lower,but the total hospitalization days and total hospitalization expenses were significantly increased(P <0.05).CONCLUSION: Endoscopic intestinal stenting combined with elective surgery for left colon cancer and rectal cancer intestinal obstruction is safe and feasible,and elective surgery should be implemented over 8 days for its security.