閉塞性左側大腸癌に対するself-expanding metallic stent留置後の原発病変切除症例の検討

Short-and middle-term outcomes in obstructive left-sided colorectal cancer treated by self-expandable metallic stent insertion followed by primary tumor resection（bridge to surgery）

◆要旨：閉塞性左側大腸癌に対してself-expanding metallic stent（以下，SEMS）留置によるbridge to surgery（以下，BTS）が行われるようになってきた．2013年1月から2020年12月まで当科で原発病変切除を行った閉塞性左側大腸癌34例を対象とし，SEMS留置群（以下，S群：22例）と一時的人工肛門造設群（以下，DS群：12例）の2群間で短期および中期成績について後方視的に検討した．S群で腹腔鏡手術が多く選択され，手術時間は短く，出血量も少なかった．病理組織学的所見で有意差は認めなかった．R0切除症例の術後3年での全生存率および無再発生存率にはともに有意差を認めなかった．SEMSを用いたBTSは中期成績を大きく損なうことなく，良好な短期成績が得られるため，閉塞性左側大腸癌に対する治療選択肢の1つとして，今後さらなるエビデンスの構築が期待される．

　Bridge to surgery（BTS）using self-expandable metallic stent（SEMS）has gained popularity as a treatment for obstructive left-sided colorectal cancer. This study included patients with obstructive left-sided colorectal cancer（n＝34）whose primary lesion was resected in our department from January 2013 to December 2020. They were categorized into two groups; SEMS insertion group（S group, 22 patients）and temporary colostomy group（DS group, 12 patients）; short-and middle-term outcomes were retrospectively investigated. Laparoscopic surgery was more frequently performed in the S group with shorter operative time and less blood loss. There were no significant differences in the pathological findings between the groups. Additionally, in R0 cases, the 3-year overall and recurrence-free survival did not differ significantly. Based on these findings, BTS with SEMS might be a treatment option for left-sided obstructive colorectal cancer.