Clinical Research Of The Surgical Timing For Resectable Colorectal Cancer Complicated With Obstructions After Implantation Of SEMS

Objective: To investigate the safety of the implantation of SEMS for patients with resectable colorectal cancer complicated with obstructions,and to explore the optimal surgical timing.Method: The retrospective cohort study was adopted.The clinical data of 53 patients received limited operation after implantation of SEMS in the first hospital of China Medical University between March 2014 and August 2017 were collected.Treatments are defined as effective only if primary anastomosis was received without anastomotic leakage following in stent group,and those clinical outcomes were analyzed by receiver operator characteristic(ROC)curve.Another 42 patients diagnosed with colorectal cancer complicated with obstructions were treated with emergency surgery during the same period.The differences such as the rate of primary anastomosis,the mean operation time and length of stay between the two groups were analyzed respectively.Results: Area under the ROC curve(AUC)is 0.777 with a certain accuracy(P<0.05).Compared to those within 14 days,the rate of primary anastomosis was significantly higher in those received elective surgery over 14 days(100 vs 66.7 per cent,P<0.05),the mean operation time was significantly decreased as well(136.62±55.63 min vs 177.63±78.79 min,P<0.05).The rate of primary anastomosis was significantly higher in stent group compared to emergency surgery group(83.0 vs 28.6 per cent,P<0.01),the length of stay and hospitalization expenses were significantly increased respectively(26.4±7.9 days vs 18.4±10.8 days,91610.54±27010.47 RMB vs 45531.52±19293.56 RMB,respectively,P<0.01).Meanwhile,the mean operation time was significantly decreased in stent group(157.51±70.85 min vs 192.69±74.40 min,P<0.05),furthermore,the incidence of intrapulmonary infection and septic shock were significantly decreased respectively than emergency surgery group(0 vs 11.9 per cent,0 vs 9.5 per cent,P<0.05).Conclusion: The implantation of SEMS as a ‘Bridge’ to limited operation for patients with resectable colorectal cancer with obstructions is safe and feasible.Limited operation should be implemented over 14 days for its high security.