在9年期间,在荷兰治疗左侧阻塞性结肠癌的演变
Julie M L Sijmons1,2,3, Jan Willem T Dekker4, Jurriaan B Tuynman5
1Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Journal of the National Comprehensive Cancer Network : JNCCN
|December 16, 2024
概括
与紧急切除 (ER) 相比,左侧阻塞性结肠癌 (LSOCC) 的桥梁到手术显著降低了死亡率,特别是在老年患者中. 国家趋势显示ER的减少,有利于更安全的支架或口腔门手术.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 越来越多的证据支持在左侧阻塞性结肠癌 (LSOCC) 的紧急切除 (ER) 上架桥梁到手术 (支架或口腔支架).
- 荷兰的指导方针在2014年纳入了这一建议.
- 这项研究评估了LSOCC治疗的时间趋势和医院间变化.
研究的目的:
- 评估LSOCC治疗方法的时间趋势.
- 检查LSOCC管理中的医院间变异性.
- 为了比较不同LSOCC治疗策略的短期结果.
主要方法:
- 来自荷兰coloRectal审计 (2012-2020) 的4535名LSOCC患者的回顾性分析.
- 分类为紧急切除 (ER),半选择性切除 (SER) 和支架或静脉栓塞 (RSS) 后的切除.
- 跨治疗组30天死亡率和并发症率的比较.
主要成果:
- 观察到ER显著下降,从79.7%降至54.7%,RSS相应增加,从9.2%降至31.2%.
- 与SER (2.8%,31.2%) 和RSS (1.0%,31.5%) 相比,ER与更高的30天死亡率 (6.2%) 和并发症率 (45.4%) 相关.
- 老年患者 (≥70岁) 的死亡率显著降低,RSS (1.6%) 与ER (9.5%) 相比.
结论:
- 国家LSOCC治疗已经从急诊转向桥梁到手术,尽管医院坚持不同.
- 与ER相关的高死亡率,特别是在老年患者中,加强了桥梁到手术的指导方针建议.
- 优化LSOCC管理需要更广泛地采用少入侵的初始程序.
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