Clinical Study Of Stent Bridging Surgery In Patients With Colorectal Cancer And Acute Ileus

Objective:1.To compare the short-term outcomes and long-term outcomes of Stent as bridge to surgery(SBTS)and Emergency surgery(ES)in patients with colorectal cancer complicated with acute ileus.2.To investigate the effect of different bridging times on the prognosis of patients treated with SBTS.Method:1.Clinical data of 90 patients with colorectal cancer complicated with acute ilobstruction who received SBTS or ES treatment in Shaanxi Provincial People’s Hospital and Affiliated Hospital of Yan ’an University from January 2015 to January 2020 were retrospectively analyzed,and they were divided into SBTS group and ES group according to different treatment methods.The data of postoperative complication rate,stage Ⅰ anastomosis rate,recurrence rate and mortality of the two groups were statistically analyzed.2.Patients in the SBTS group were divided into groups according to the different bridging time to compare the differences in the prognosis of patients with different bridging time.Results:1.The laparoscopic surgery rate of 49 patients in the SBTS group and 41 patients in the ES group [89.8%(44/49)vs.7.3%(3/41),P < 0.001],the intraoperative stage I anastomosis rate [83.7%(41/49)vs.36.6%(15/41),P < 0.001],colostomy rate [16.3%(8/49)vs 65.9%(27/41),P < 0.001),radical surgery complications [12.2%(6/49)vs 34.1%(14/41),P=0.013],median postoperative exhaust time(3 days vs.5 days,P=0.015),median number of intraoperative lymph nodes dissection(14 vs.12,P < 0.001),median hospitalization cost(82,500 yuan vs.68,300 yuan,P < 0.001),the median length of hospital stay(23 days vs.17 days,P=0.073)and other differences were statistically significant.There were no significant differences in postoperative ICU occupancy,median operation duration,median postoperative hospital stay,total mortality and recurrence rate between the two groups(P > 0.05).The results of K-M survival analysis showed no significant difference in long-term survival between the two groups(P > 0.05).Multivariate Cox regression analysis of 90 enrolled patients showed that stenting had no significant effect on patients’ OS and DFS.2.Among the 49 patients in the SBTS group,3 patients were transferred to emergency surgery after stent-related complications.After excluding these 3 patients,the remaining 46 patients were grouped according to the median bridging time.The results showed that Median postoperative exhaust time(3.0 vs.3.5 days),postoperative ICU occupancy rate(0% vs.8.3%),median number of intraoperative lymph nodes dissection(15.5 vs.14.0),and median operative duration(322.5min vs.322.5min)in the < 8-day and ≥ 8-day bridging groups.252.5min),total complication rate(4.5% vs.20.8%),recurrence rate(27.3% vs.41.7%),mortality rate(22.7% vs.37.5%)were not statistically significant(P > 0.05).Survival analysis showed no significant difference in long-term survival between the two groups(P > 0.05).Multivariate Cox regression analysis of the46 patients treated with bridging surgery showed that age ≥65 years(HR=5.610,95%CI1.220-25.797,P=0.027)was an independent risk factor for OS.Lymph node metastasis(HR=3.233,95% CI 1.032-10.130,P=0.044)was an independent risk factor for DFS.3.The total technical success rate of stent implantation was 94.3%(50/53),the clinical success rate was 92.5%(49/53),the incidence of stent-related complications was6.1%(3/49),the incidence of stent-related perforation was 4.1%(2/49),and the incidence of stent re-obstruction was 2.0%(1/49).Conclusion:1.Compared with the ES group,SBTS group has the advantages of higher laparoscopic surgery rate,higher stage Ⅰ anastomosis rate,and shorter postoperative intestinal function recovery time,and can reduce the short-term postoperative complication rate and fistula rate,while there is no significant difference in long-term survival.Although the cost of hospitalization was higher and the length of stay was longer in the SBTS group,in general,bridging surgery brought better short-term efficacy and did not produce poor long-term prognosis,and its effectiveness and safety are worthy of recognition.2.The total postoperative complication rate and long-term survival of patients in the bridging time < 8 days group were better than those in the bridging time ≥8 days group,but the difference was not statistically significant.3.At present,intestinal stent implantation has achieved a high technical success rate,and the incidence of stent-related complications has also decreased.