结肠直肠支架作为一座桥梁,用于阻塞性结肠直肠癌的手术,是否会增加围神经的入侵?
Hiroki Kato1,2, Kazushige Kawai1, Daisuke Nakano1
1Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Journal of the anus, rectum and colon
|August 1, 2024
概括
对于阻塞性结直肠癌 (CRC) 的自扩展金属支架 (SEMS) 放置与周围神经侵入 (PNI) 的增加有关. 然而,在支架患者和未支架患者之间,预后是相似的,这表明SEMS是晚期CRC的可行选择.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
背景情况:
- 阻塞性结直肠癌 (CRC) 带来了治疗挑战.
- 自扩展金属支架 (SEMS) 用于息,但它们对瘤生物学的影响,特别是围神经侵入 (PNI),尚不清楚.
研究的目的:
- 调查SEMS对阻塞性CRC的放置是否会增加PNI.
- 评估SEMS对阻塞性CRC患者预后的影响.
主要方法:
- 对1022名患有病理性T3或T4结肠/直腰肌癌的患者进行了回顾性审查.
- 在三组中比较PNI发病率和严重程度:没有阻塞,没有支架的阻塞和支架的阻塞.
- 多变量分析和生存分析,以评估与PNI和整体存活率 (OS) 相关的因素.
主要成果:
- SEMS安置与PNI独立相关 (HR:2.08).
- 与没有支架 (45%) 和没有阻塞 (39%) 相比,PNI发病率在SEMS组 (68%) 中最高.
- 五年后的OS在SEMS安置和没有支架组的阻塞之间是可比的 (73.1%与76.7%),并且比没有阻塞 (86.3%) 更好. 阻塞是OS降低的一个独立风险因素 (HR: 1.57).
结论:
- 阻塞性CRC的SEMS放置与PNI增加有关.
- 尽管增加了PNI,但与没有支架的阻塞相比,SEMS安置不会使预后恶化.
- 在阻塞性CRC中,SEMS是桥梁到手术 (BTS) 的可行的治疗选择.
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