Background: Managing patients with obstructing rectal cancer is challenging due to the risks of gastrointestinal obstruction and perforation. This study evaluates the outcomes of pre-emptive laparoscopic colostomy creation in patients with locally advanced rectal and anal cancer to prevent symptoms and facilitate therapy initiation. Methods: This retrospective cohort study includes patients with locally advanced rectal or anal cancer assessed by our Colorectal Multidisciplinary Team from January 2017 to February 2024. Patients who underwent pre-emptive laparoscopic colostomy were compared to a control group of non-obstructing rectal cancer patients who started direct oncological treatment. The primary endpoint was the time from diagnosis to the initiation of oncological treatments. The secondary endpoints were the rate and timing of subsequent radical resection, surgical morbidity and hospital stay. A Weibull regression was used to evaluate the time differences between the groups. Results: There were 37 patients who received pre-emptive laparoscopic colostomy, compared to 207 control patients. The mean time from diagnosis to the start of neoadjuvant therapy was 38.3 ± 2.3 days. Despite higher rates of malnutrition and more advanced stages in the colostomy group, no significant differences were observed in the time to start therapy (p= 0.083) or time to radical resection (p= 0.187) between the groups. The laparoscopic procedure showed low rates of postoperative complications and acceptable lengths of stay. Discussion and Conclusions: Pre-emptive laparoscopic colostomy is a feasible approach for managing obstructing rectal or anal cancer. Treatment timelines were not extended compared to timelines for non-obstructing cases, despite differences in nutritional status and staging. Further prospective studies with larger cohorts are needed to validate these findings and refine treatment protocols for obstructing gastrointestinal malignancies.
背景：梗阻性直肠癌患者因存在胃肠道梗阻和穿孔风险，其临床管理具有挑战性。本研究旨在评估预防性腹腔镜结肠造口术在局部晚期直肠癌和肛管癌患者中的应用效果，以预防症状发生并促进治疗启动。 方法：本回顾性队列研究纳入2017年1月至2024年2月期间经结直肠多学科团队评估的局部晚期直肠癌或肛管癌患者。将接受预防性腹腔镜结肠造口术的患者与直接开始肿瘤治疗的未梗阻直肠癌对照组进行比较。主要终点为从确诊到开始肿瘤治疗的时间。次要终点包括后续根治性切除的比例与时机、手术并发症发生率及住院时间。采用威布尔回归分析评估组间时间差异。 结果：预防性腹腔镜造口组共37例患者，对照组207例。从确诊到开始新辅助治疗的平均时间为38.3±2.3天。尽管造口组患者营养不良比例更高、分期更晚，但两组在开始治疗时间（p=0.083）和根治性切除时间（p=0.187）方面均未观察到显著差异。腹腔镜手术术后并发症发生率较低，住院时间处于可接受范围。 讨论与结论：预防性腹腔镜结肠造口术是处理梗阻性直肠癌或肛管癌的可行方案。尽管存在营养状态和分期的差异，其治疗时间线与未梗阻病例相比并未延长。未来需要更大样本的前瞻性研究来验证这些发现，并完善梗阻性胃肠道恶性肿瘤的治疗方案。
肿瘤(癌症)患者之家