Korean Journal of Gastrointestinal Endoscopy 2007;35(5): 321-327.
장폐쇄가 동반된 대장암에 대한 초기치료로서 수술 전 자가팽창성 금속스텐트 삽입술과 응급 수술의 비교
서정필ㆍ김상우ㆍ백창렬ㆍ박재명ㆍ조유경ㆍ이인석ㆍ최명규ㆍ최규용ㆍ정인식ㆍ강원경*ㆍ오승택*
가톨릭대학교 의과대학 내과학교실, *외과학교실
A Comparison of the Use of Self-Expanding Metallic Stent Insertion with Emergency Surgery as an Initial Treatment for Obstructive Colorectal Cancer
Jung Pil Suh, M.D., Sang Woo Kim, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D.,Yu Kyung Cho, M.D., In Seok Lee, M.D., Myung Gyu Choi, M.D., Kyu Yong Choi, M.D.,In Sik Chung, M.D., Won Kyung Kang, M.D.* and Seong Taek Oh M.D.*
Departments of Internal Medicine and *Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
Abstract
Background/Aims: Emergency surgery for obstructive colorectal cancer is associated with a high rate of postoperative complications. The objective of this study is to investigate the clinical difference between the use of elective surgery after stent insertion, and the performance of emergency surgery as an initial treatment for colorectal cancer with an intestinal obstruction. Methods: For patients that were admitted from February 2004 to June 2006 for obstructive colorectal cancer, a retrospective analysis on the clinical outcome was performed for a group of patients that received a stent as an initial treatment (stent group) and a group of patients that received emergency surgery as an initial treatment (emergency operation group). Results: Postoperative complications in the stent group included pneumonia and wound infection (9.5%). For the emergency operation group, postoperative complications included sepsis, deep vein thrombosis, wound infection, anastomosis leakage and postoperative bleeding (38.9%). The number of postoperative complications were significantly less in patients in the stent group than for patients in the emergency operation group (p=0.032). The number of a one-staged operation was significantly higher in the stent group compared with the emergency operation group (85.7% vs 55.6%; p=0.039). The number of a stoma created at least once was significantly lower in the stent group (14.3% vs 50%; p=0.017) than in the emergency operation group. Conclusions: As an initial treatment for an obstructive colorectal cancer, the use of stent insertion for primary management should be considered since it can reduce the degree of postoperative complications and the necessity for multi-staged operations. (Korean J Gastrointest Endosc 2007;35:321-327)
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