Efficacy Analysis Of Colonic Stent Placement Combined With Surgery In The Treatment Of Obstructive Colorectal Cancer

Objective:The clinical data of patients with obstructive colorectal cancer were collected,the prognosis of colonic stent implantation combined with emergency operation was compared,and the safety and efficacy of colonic stent in the treatment of colorectal cancer and the effect of combined operation were analyzed.Methods:The clinical data of patients with obstructive colorectal cancer（OCRC）treated in China-Japan Union Hospital of Jilin University from January 2016 to June 202 1 were analyzed retrospectively.all the patients were admitted because of acute intestinal obstruction,and the relevant examination showed that colorectal cancer was associated with obstruction.emergency operation or colonic stent implantation combined with limitedterm operation was given,and the pathological return clearly indicated colorectal adenocarcinoma.According to the inclusion and exclusion criteria,a total of 96 patients with obstructive colorectal cancer were collected,including 47 patien ts undergoing limited operation after stent implantation and 49 patients undergoing emergency operation.All patients were divided into stent group and emergency operation group,including43 cases of stent combined with laparoscopic surgery,4 cases of laparotomy,10 cases of emergency laparoscopic surgery and 39 cases of laparotomy.All patients with stents underwent surgical treatment after complete remission of abdominal distension after stenting,while patients in the emergency operation group underwent direct operation after conservative treatment.The clinical effects of the two groups were compared.The main results were as follows: operation mode,operation method,stoma formation,operation time,intraoperative blood loss,number of lymph node dissec tion,postoperative ICU transfer rate,perioperative mortality,postoperative parenteral nutrition time,postoperative complications,postoperative hospital stay,unplanned secondary operation,postoperative overall survival and disease-free survival.Results:There was no significant difference between the stent group and the emergency group in terms of age（P=0.59）,sex ratio（P=0.31）,BMI（P=0.32）,associated underlying diseases（P=0.67）,ASA grade（P=0.42）and previous abdominal surgery history（P=0.24）,smoking history（P=0.70）,drinking history（P=0.20）.There were some differences in oncology characteristics,and the number of patients with right colon cancer in the emergency group（8 cases,16.33%）was significantly higher than that in the stent group（0cases,0%）.There was no significant difference in tumor differentiation,maximum diameter,preoperative carcinoembryonic antigen,TNM stage,neurovascular invasion and distal margin between the two groups.Compared with the operation,the resection rate of the primary focus was almost the same between the two groups（P>0.05）.39 patients（90.70%）in the stent group underwent laparoscopic tumor resection,while only 18patients（41.86%）in the emergency group underwent laparoscopic surger y.there was significant difference between the two groups（P<0.001）.The rate of colostomy in stent group was significantly lower than that in emergency operation group（16.28% vs 55.81%,P<0.0l）.There were 3 cases in stent group（6.98%）,19 cases in emergen cy group（44.19%）and more in emergency group（P<0.05）.The operation time of stent group and emergency group was 176.68 ±28.51 min and 196.90 ±55.69 min,respectively,and the amount of operative bleeding was 29.36 ±20.87 ml and 91.53 ±59.34 ml,respectively（P<0.001）.In addition,there were significant differences in postoperative parenteral nutrition time（P<0.05）,number of intraoperative lymph node dissection（stent group）and emergency group（P<0.01）,postoperative ICU transfer rate（P<0.03）and ventilator-assisted respiration（P<0.02）.However,there was no significant difference in unplanned secondary operation（P>0.05）and postoperative hospital stay（P>0.05）.The results of Kaplan-Maier survival curve showed that there was no significant difference in overa ll survival time and disease-free survival time between the two groups.Univariate logistic regression analysis showed that stent implantation had no significant effect on postoperative long-term death in patients with colorectal cancer（P<0.549）.The result s showed that no postoperative chemotherapy and lymph node metastasis were related to postoperative long-term death.Multivariate logistic regression analysis showed that lymph node metastasis（OR=8.900,95%CI:2.583-30.658,P<0.05）and no postoperative chemotherapy（OR=3.762,95%CI:1.276-11.087,P<0.05）were independent risk factors for long-term death in patients with OCRC.Conclusions:1.For patients with obstructive colorectal cancer considering radical resection and without obvious surgic al and stent contraindications,stent implantation as a limited BTS is safe and effective,and endoscopy is more meaningful for stent implantation in splenic flexure and proximal colon.2.Compared with emergency operation,stent implantation can increase the rate of laparoscopic operation and lymph node dissection,reduce the rate of colostomy,and reduce the time of operation and the amount of bleeding during operation.However,for obstructive right colon cancer,emergency surgery can be considered when stent implantation is difficult and risky.3.Stent implantation combined with limited surgical treatment can reduce perioperative complications.4.Stent implantation had no significant effect on the long-term prognosis of the patients.Lymph node metasta sis and absence of postoperative chemotherapy are independent risk factors for long-term death.