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폐쇄성 좌측 대장암의 일차치료로서 스텐트와 응급수술의 임상성적 비교

Comparison of Self-Expanding Metallic Stenting with Emergency Surgery as First- Management for Obstructing Primary Left- sided Colorectal Cancer

대한대장항문학회지 2006년 22권 1호 p.41 ~ 46
박지원 ( Park Ji-Won ) - 서울대학교 의과대학 내과학교실

이민로 ( Lee Min-Ro ) - 서울대학교 의과대학 외과학교실
홍창원 ( Hong Chang-Won ) - 서울대학교 의과대학 외과학교실
박형철 ( Park Hyung-Chul ) - 서울대학교 의과대학 외과학교실
윤상남 ( Yoon Sang-Nam ) - 서울대학교 의과대학 외과학교실
 ( Kim Se-Hyung ) - 서울대학교 의과대학 방사선과학교실
한준구 ( Han Jun-Gu ) - 서울대학교 의과대학 방사선과학교실
박규주 ( Park Kyu-Joo ) - 서울대학교 의과대학 외과학교실
박재갑 ( Park Jae-Gahb ) - 서울대학교 의과대학 외과학교실

Abstract


Purpose: Emergency surgery has been a conventional treatment for malignant large-bowel obstruction, but is associated with high morbidity and mortality. Recently, self-expanding metallic stents (SEMS) have provided a new modality as palliation or bridge therapy for patients with obstructing colorectal cancers. The purpose of the present study is to evaluate whether SEMS is useful in patients with malignant large bowel obstruction.

Methods: Between January 1999 and June 2004, 63 patients were treated for primary obstructing left-side colorectal cancer at the Department of Surgery, Seoul National University Hospital. 32 patients were managed firstly with SEMS (stent group), and 31 patients underwent an emergency operation (emergency surgery group). Clinical data were retrospectively reviewed. The results, including perioperative outcome and survival, were compared between the two groups.

Results: Clinicopathological parameters, including age, gender, ASA grade, tumor location and stage, were similar between the two groups. The rate of one-stage operations was significantly higher in the stent group (52% vs 13%; P=0.004). The stent group was associated with a lower rate of stoma formation (48% vs 87%; P=0.004), a shorter length of hospital stay (19 days vs 26 days; P=0.048), and fewer complications (7% vs 30%; P= 0.035). The overall and the disease-free survival rates were similar between the two groups (P=0.973, 0.126). The stent group was associated with fewer surgeries needed, shorter length of hospital stay, and fewer complications.

Conclusions: Stenting with SEMS is useful in managing malignant large-bowel cancer with obstruction and may be better than traditional open surgery. J Korean Soc Coloproctol 2006;22:41-46

키워드

대장 폐쇄;직장결장암;자가 확장성 금속 스텐트
Colonic obstruction;Colorectal cancer;Self-expanding metallic stents
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