Clinical Study Of The Application Of Self-expanding Metallic Stents Without Fluoroscopic Monitoring For Malignant Colorectal Obstruction

Application of colonoscopic placement of self-expandable metal stent without fluoroscopic monitoring for malignant colorectal obstructionObjective:Our aim is to evaluate the efficacy and safety of colonoscopy guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstructionMethods:142 cases of obstructive colorectal cancer in 98 cases of male and 44 cases of women.The mean age of the patient was 20-94 years(61.8 ± 15.4).Retrospectively analysis the clinical data of 142 patients who undergo colonoscopy guided placement of self expandable metallic stents without fluoroscopic monitoring for a cute malignant colorectal obstruction between October 2007 to December 2015.Colletct and analyze demography(gender,age),technical success rate and clinical success rate of SEMS implantation.Results The obstruction was in the rectum(n=38),sigmoid(n=54),descending colon(n=28),splenic flexure(n=4),transverse colon(n=7),hepatic flexure(n=9)and ascending colon(n=3).The technical success rate of stent implantation was 99.3%(141/142),and the clinical success rate was 98.6%(140/142).The mean time of operation was(10.4 ± 11.2)min(range1.1 to 61.0 min).No serious procedure related complication occurred.49.3%(70/142)of patients undergoing palliative surgery with SEMS were enrolled in this study.Patients who underwent sequential colorectal cancer surgery after SEMS implantation were 50.7%(72/142).Conclusions Colonoscopy guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for a cute malignant colorectal obstruction is effective and safe technique as either a palliative measure or as a bridge to subsequent resection.Clinical study of the application of self-expanding metallic stents without fluoroscopic monitoring for malignant colorectal obstructionObjective:This study aims to compare the clinical effect of self-expanding metallic stents as a bridge to surgery(SEMS group)with those of emergency surgery(ES group)for malignant colorectal obstruction(MCO).Methods:Adopting the method of retrospective study.The clinical data of 142 patients with MCO who accepted operation treatment at the Second Military Medical University Chang-Hai Hospital between October 2007 and December 2015 were collected.72 patients who underwent semi-elective curative resection after endoscopic SEMS insertion were included in the SEMS group,70 patients who underwent emergency curative surgery were included in ES group.The incidence of primary anastomosis,stoma rate,laparoscopic surgery rate,mortality,postoperative morbidity,ICU admission rate,the number of lymph node cleaned,operation time? hospital stay,and hospitalization costs were compared between the two groups.The multidisciplinary discussion and evaluation was given to these patients preoperative.Results:The incidence of primary anastomosis in SEMS group was significantly higher than that in ES group(83.3% vs 61.4%,P=0.003);The stoma rate in SEMS group was significantly lower than that in ES group(16.7vs 38.6%,(P=0.022));Patients in SEMS group underwent more laparoscopies surgery than in ES group(9.7% vs 0%,P=0.022);The postoperative ICU admission rate in SEMS group was lower than that in ES group(7.2% vs 38.6%,P<0.001);The number of lymph node cleaned in SEMS group was more than that in ES group[(17.97±2.83)vs(15.44±4.48),P<0.001];The operation time in SEMS group was significantly shorter than that in ES group[(126.65±27.52)min vs(167.70±27.31)min,P<0.001]?min,P<0.001];The median length of hospital stay in SEMS group was significantly shorter than that in ES group(9d vs 16.5d,P<0.001);The median hospitalization costs in SEMS group was significantly less than that in ES group(38769.00 vs 56692.50,P<0.001).The mortality in SEMS group was lower than that in ES group(0%vs 2.9%).Conclusions:SEMS can effectively relieve the obstruction caused by colorectal cancer,and change the traditional emergency surgery into a selective surgery with better outcomes.SEMS appears to be a valuable technique for malignant colorectal obstruction,it can create conditions and time for medical evacuation or referral.Survival rate analysis of endoscopic stenting as a bridge to surgery without fluoroscopic monitoring for malignant colorectal obstructionObjective : This study aims to compare the long-term oncologic outcomes of self-expanding metallic stents as a bridge to surgery with those of emergency surgery for malignant colorectal obstruction(MCO).Methods:We collected a retrospective analysis of 60 patients with obstructive colorectal cancer who underwent surgery in Changhai Hospital of Second Military Medical University from October 2007 to December 2012.The experimental group(27 patients)underwent semi-elective curative resection after endoscopic SEMS insertion,the control group(33 patients)underwent emergency curative surgery.The clinical and pathological features,perioperative status,3-year survival rate and 5-year survival rate of the two groups were compared.Results:There were no statistically significant differences between the experimental group and the control group in terms of general data,tumor stage,and tumor location.The operative time,length of hospital stay and stoma rate in the experimental group were better than those in the control group.There was no significant difference in the overall survival rate(55.6% vs 39.4%)and 5-year overall survival rate(48.1% vs 36.4%)between the experimental group and the control group(P>0.01).Conclusions:There is no significant difference in the overall survival rate between SEMS sequential surgery for obstructive colorectal cancer and emergency surgery for obstructive colorectal cancer.