研究单位：[1]Beijing Chao Yang Hospital[2]Beijing Friendship Hospital Beijing,Beijing,China,100020[3]Beijing Hospital Beijing,Beijing,China,100020[4]Chinese People's Liberation Army General Hospital Beijing,Beijing,China,100020[5]Xuanwu Hospital Capital Medical University Beijing,Beijing,China,100020[6]Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences Beijing,Beijing,China,100021[7]the Sixth Affiliated Hospital of Sun Yat-Sen University Guangzhou,Guangdong,China,510655[8]the First Affiliated Hospital of Guangxi Medical University Nanjing,Guangxi,China,530021[9]Fourth Hospital of Hebei Medicial University Shijiazhuang,Hebei,China,050011[10]First Affiliated Hospital of Jiamusi University Jiamusi,Heilongjiang,China,154003[11]the 150th Central Hospital of Chinese PLA Luoyang,Henan,China,471031[12]the First Affiliated Hospital of Zhengzhou University Zhengzhou,Henan,China,450000[13]the Second Affiliated Hospital of Zhengzhou University Zhengzhou,Henan,China,450014[14]Hubei Cancer Hospital Wuhan,Hubei,China,430000[15]Hubei General Hospital Wuhan,Hubei,China,430060[16]Zhongnan Hospital of Wuhan University Wuhan,Hubei,China,430071[17]the Third Xiangya Hospital of Central South University Changsha,Hunan,China,410000[18]Hunan Provincial People'S Hospital Changsha,Hunan,China,410005[19]China-Japan Union Hospital of Jilin University Changchun,Jilin,China,130033[20]Shengjing Hospital of China Medical University Shenyang,Liaoning,China,110004[21]the First Affiliated Hospital of Dalian Medical University Dalian,Shandong,China,116011[22]Shandong Provincial Qianfoshan Hospital Jinan Shi,Shandong,China,250014[23]Shandong General Hospital Jinan Shi,Shandong,China,250021[24]Qilu Hospital of Shandong University Jinan,Shandong,China,250022[25]the Affiliated Hospital of Qingdao University Qingdao,Shandong,China,266000[26]Changhai Hospital Shanghai,Shanghai,China,200000[27]Shanxi Tumor Hospital Taiyuan,Shanxi,China,030013[28]the First Affiliated Hospital of Xi'An Jiaotong University Xi'an,Shanxi,China,710061[29]West China Hospital Sichuan University Chengdu,Sichuan,China,610041[30]the First Affiliated Hospital of Zhejiang University Hangzhou,Zhejiang,China,310003[31]Jinhua Hospital of Zhejiang University Jinhua,Zhejiang,China,321000[32]the Second Affiliated Hospital of Wenzhou Medical University Wenzhou,Zhejiang,China,325027
研究目的：
Colorectal cancer is the fourth most common cancer in China. Up to 30% of patients with colorectal cancer present with an emergency obstruction of the large bowel at the time of diagnosis, and 70% of all malignant obstruction occurs in the left-sided colon. Patients with obstruction are associated with worse oncologic outcomes compared with those having nonobstructive tumors. Conventionally, patients with malignant large bowel obstruction receive emergency surgery, with morbidity rates of 30%-60% and mortality rates of 7-22%, and about two-thirds of such patients end up with a permanent stoma.
Self-expanding metallic stents (SEMS) haven been used as a bridge to surgery (to relieve obstruction prior to elective surgery) in patients with potentially resectable colorectal cancer. Several clinical trials demonstrate that SEMS as a bridge to surgery may be superior to emergency surgery considering the short-term outcomes. SEMS is associated with lower morbidity and mortality rate, increased primary anastomosis rate, and decreased stoma creation rate. Although about half of patients can achieve primary anastomosis after stent placement, the primary anastomosis rate is still significantly lower compared with nonobstructing elective surgery. The interval between stent placement and surgery may be not long enough that bowel decompression is insufficient at the time of operation. Furthermore，the long-term oncologic results regarding SEMS as a bridge to surgery are still limited and contradictory. Sabbagh et al. suggest worse overall survival of patients with SEMS insertion compared with emergency surgery, the 5-year cancer-specific mortality was significantly higher in the SEMS group (48% vs 21%, respectively, P=0.02). One interpretation is that tumor cells may disseminate during the procedure of colonic stenting placement. We hypothesis that immediate chemotherapy after stenting may improve overall survival by eradicating micrometastasis. Moreover, neoadjuvant chemotherapy prolongs the interval between stent placement and surgery, and the time for bowel decompression is more sufficient, which may increase the success rate of primary anastomosis and decrease risk of stoma formation.
