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Mihailov R, Dima C, Constantin BG, Dimofte F, Craescu M, Moroianu L, Candussi LI, Lutenco V, Mihailov OM, Lutenco V. Prognostic Factors of Postoperative Mortality in Patients with Complicated Right Colon Cancer. Life (Basel) 2025; 15:350. [PMID: 40141695 PMCID: PMC11943528 DOI: 10.3390/life15030350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/14/2025] [Accepted: 02/21/2025] [Indexed: 03/28/2025] Open
Abstract
The incidence of right colon cancer presenting in a stage with complications is significant. There are major differences in therapeutic approach between elective colon cancer surgery and emergency surgery. Complications such as hemorrhage, obstruction, and perforation require careful evaluation of prognostic factors, with morbidity and mortality rates being much higher compared to elective colon surgery. We retrospectively analyzed a group of 95 patients admitted in an emergency to the County Emergency Hospital St. Apostol Apostol Andrei Galati with complicated tumors of the right colon-occlusive, perforated, or hemorrhagic. A series of clinical and biological parameters were followed in order to identify the prognostic factors in the occurrence of death. We analyzed the specialized literature, comparing our study with other similar research from the most important databases. The postoperative death rate in patients with complicated right colon cancer was high. Most complications were occlusive, followed by hemorrhagic and perforative.
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Affiliation(s)
- Raul Mihailov
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
- “Sf. Apostol Andrei” County Emergency Clinical Hospital, 800008 Galați, Romania
| | - Corina Dima
- “Dunarea de Jos”Faculty of Sciences and Environment, University of Galati, 800008 Galați, Romania
| | - Bianca Georgiana Constantin
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
| | - Florentin Dimofte
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
- “Sf. Apostol Andrei” County Emergency Clinical Hospital, 800008 Galați, Romania
| | - Mihaela Craescu
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
| | - Lavinia Moroianu
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
| | - Laura Iuliana Candussi
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
| | - Virginia Lutenco
- “Sf. Ioan” Emergency Clinical Hospital for Children, 800008 Galați, Romania;
| | - Oana Mariana Mihailov
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
| | - Valerii Lutenco
- “Dunarea de Jos” Faculty of Medicine and Pharmacy, University of Galati, 800008 Galați, Romania; (R.M.); (B.G.C.); (F.D.); (M.C.); (L.M.); (L.I.C.); (O.M.M.); (V.L.)
- “Sf. Apostol Andrei” County Emergency Clinical Hospital, 800008 Galați, Romania
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Han JH, Lee BC, Kim MJ, Choi JB, Jung HJ, Jo HJ. Surgery for colorectal cancer in people aged 80 years or older - complications, risks, and outcomes. Medicine (Baltimore) 2024; 103:e40696. [PMID: 39686511 PMCID: PMC11651447 DOI: 10.1097/md.0000000000040696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 11/07/2024] [Indexed: 12/18/2024] Open
Abstract
The number of older adult patients with colorectal cancer (CRC) is steadily increasing with the increasing aging population. However, healthcare professionals continue to approach treatment in older adult patients while considering the potential coexistence of complications relative to their age. There is a tendency to define and limit treatment options for managing "older adult patients" at relatively younger ages. Given the progression of aging societies and aging of patients with CRC, the impact of age on post-surgical outcomes should be analyzed to guide treatment decisions and ensure the highest quality of care for this population. This study aimed to compare outcomes in patients aged approximately 80 years who have undergone surgery after being diagnosed with CRC at the National Pusan University Hospital. This retrospective observational study included 502 patients who underwent surgery after being diagnosed with CRC at Pusan National University Hospital from January 2018 to December 2022. All surgeries were performed by a single surgeon. Older adult patients underwent open surgery more frequently. No significant differences in surgical outcomes or hospital stay were found between the two groups. Moreover, no notable differences were observed in overall complications, including major surgery-related complications such as anastomotic leakage, bleeding, and infection, between the two groups. However, pneumonia was significantly more common in the older patient group (P = .016). Among patients requiring emergency surgery, the older adult group demonstrated a significantly higher proportion of emergency surgeries and complications associated with regular surgeries compared with the younger group. In older adult patients, the risk of postoperative complications should not be determined solely based on age; a comprehensive assessment is necessary. However, in the case of emergency surgery, older adult patients may be relatively vulnerable compared with younger patients.
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Affiliation(s)
- Jeong Hee Han
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Biomedical Research Institute, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Biomedical Research Institute, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Min Ju Kim
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Pusan National University, School of Medicine, Busan, Republic of Korea
| | - Hong Jae Jo
- Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Department of Surgery, Pusan National University, School of Medicine, Busan, Republic of Korea
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Gu H, Lee S, Kim S, Jang HL, Choi DW, Kim KS, Shin YR, Cheung DY, Lee BI, Kim JI, Lee HH. Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea. Clin Endosc 2024; 57:790-797. [PMID: 39308325 PMCID: PMC11637659 DOI: 10.5946/ce.2024.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND/AIMS Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement. METHODS All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings. RESULTS The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved. CONCLUSIONS This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.
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Affiliation(s)
- Hyundam Gu
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suyoung Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | - Kyu Seok Kim
- Interventional Research Center, M. I. Tech Co., Ltd., Pyeongtaek, Korea
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Young Cheung
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sekioka A, Ota S, Ito T, Mizukami Y, Tsuboi K, Okamura M, Lee Y, Ishida S, Shim Y, Adachi Y. Long-Term Outcomes of Self-Expandable Metallic Stents as a Bridge to Surgery for Obstructive and Symptomatic Primary Tumors of Stage IV Colorectal Cancer: A Propensity-Score Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:561-567. [PMID: 38574310 DOI: 10.1089/lap.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: Self-expandable metallic stent (SEMS) was introduced for the treatment of obstructive colorectal cancer (CRC) a few decades ago. However, its long-term outcomes remain controversial, especially for stage IV CRC. The aim of this study was to clarify the outcomes of SEMS as a "bridge to surgery" (BTS) for obstructive and symptomatic primary tumors in stage IV CRC by one-to-one propensity-score matching. Materials and Methods: This retrospective cohort study was conducted at a single center from January 2007 to December 2017. Patients with obstructive and symptomatic primary tumors of stage IV CRC underwent primary resection (PR) or placement of a SEMS as a BTS. They were divided into SEMS and PR groups, and their short- and long-term outcomes were compared. Results: In total, 52 patients were reviewed (SEMS group, 21; PR group, 31). Sixteen patients in both groups were matched using propensity scores. Patients in the SEMS group more frequently underwent laparoscopic surgery than those in the PR group (75% versus 19%, P = .004). The two groups showed no significant differences in perioperative and pathological outcomes. The 5-year overall survival was not significantly different between groups (29% versus 20%, P = .53). Conclusions: As a BTS, the use of SEMS for obstructive and symptomatic primary tumors in CRC stage IV can be a comparable option to PR in terms of short- and long-term outcomes, and would be less invasive with respect to surgical procedures.
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Affiliation(s)
- Akinori Sekioka
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Shuichi Ota
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Tetsuo Ito
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yo Mizukami
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Kunihiko Tsuboi
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Masahiko Okamura
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yoo Lee
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Satoshi Ishida
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yugang Shim
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yukito Adachi
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
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McHugh FT, Ryan ÉJ, Ryan OK, Tan J, Boland PA, Whelan MC, Kelly ME, McNamara D, Neary PC, O'Riordan JM, Kavanagh DO. Management Strategies for Malignant Left-Sided Colonic Obstruction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Propensity Score Matching Studies. Dis Colon Rectum 2024; 67:878-894. [PMID: 38557484 DOI: 10.1097/dcr.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The optimal treatment strategy for left-sided malignant colonic obstruction remains controversial. Emergency colonic resection has been the standard of care; however, self-expanding metallic stenting as a bridge to surgery may offer short-term advantages, although oncological concerns exist. Decompressing stoma may provide a valid alternative, with limited evidence. OBJECTIVE To perform a systematic review and Bayesian arm random-effects model network meta-analysis comparing the approaches for management of malignant left-sided colonic obstruction. DATA SOURCES A systematic review of PubMed, Embase, Cochrane Library, and Google Scholar databases was conducted from inception to August 22, 2023. STUDY SELECTION Randomized controlled trials and propensity score-matched studies. INTERVENTIONS Emergency colonic resection, self-expanding metallic stent, and decompressing stoma. MAIN OUTCOME MEASURES Oncologic efficacy, morbidity, successful minimally invasive surgery, primary anastomosis, and permanent stoma rates. RESULTS Nineteen of 5225 articles identified met our inclusion criteria. Stenting (risk ratio 0.57; 95% credible interval, 0.33-0.79) and decompressing stomas (risk ratio 0.46, 95% credible interval: 0.18-0.92) resulted in a significant reduction in the permanent stoma rate. Stenting facilitated minimally invasive surgery more frequently (risk ratio 4.10; 95% credible interval, 1.45-13.13) and had lower overall morbidity (risk ratio 0.58; 95% credible interval, 0.35-0.86). A pairwise analysis of primary anastomosis rates showed increased stenting (risk ratio 1.40; 95% credible interval, 1.31-1.49) compared with emergency resection. There was a significant decrease in the 90-day mortality with stenting (risk ratio 0.63; 95% credible interval, 0.41-0.95) compared with resection. There were no differences in disease-free and overall survival rates, respectively. LIMITATIONS There is a lack of randomized controlled trials and propensity score matching data comparing short-term and long-term outcomes for diverting stomas compared to self-expanding metallic stents. Two trials compared self-expanding metallic stents and diverting stomas in left-sided malignant colonic obstruction. CONCLUSIONS This study provides high-level evidence that a bridge-to-surgery strategy is safe for the management of left-sided malignant colonic obstruction and may facilitate minimally invasive surgery, increase primary anastomosis rates, and reduce permanent stoma rates and postoperative morbidity compared with emergency colonic resection.
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Affiliation(s)
- Fiachra T McHugh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Éanna J Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Odhrán K Ryan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Jonavan Tan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Patrick A Boland
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Maria C Whelan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Michael E Kelly
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - James M O'Riordan
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Colorectal Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
- Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin, Ireland
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Kim DH, Lee HH. Colon stenting as a bridge to surgery in obstructive colorectal cancer management. Clin Endosc 2024; 57:424-433. [PMID: 38454545 PMCID: PMC11294850 DOI: 10.5946/ce.2023.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 03/09/2024] Open
Abstract
Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.
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Affiliation(s)
- Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lin W, Chok AY, Seow-En I, Tan EKW. Stenting as bridge to surgery versus upfront emergency resection for non-metastatic left sided obstructing colorectal cancer: risk of peritoneal recurrence and long-term outcomes. Surg Endosc 2024; 38:2632-2640. [PMID: 38503904 DOI: 10.1007/s00464-024-10780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Oncological outcomes of stenting as a bridge to surgery (SBTS) remain a major concern, despite perioperative benefits it offers. This study aims to evaluate the differences in recurrence patterns and survival in patients with non-metastatic, obstructing left sided colon cancers treated by SBTS versus upfront emergency surgery (ES). METHODS This is a retrospective, single-centre cohort study of 227 consecutive patients with non-metastatic, obstructing left sided colon cancer between 2007 and 2016. Primary outcomes were pattern of recurrence, and survival. Univariate, bivariate and multivariate logistic regression were done to determine relationships between factors and recurrence. Kaplan Meier curves and log rank tests were used to analyse survival outcomes. RESULTS Of the 227 patients included, 62 underwent SBTS and 165 underwent upfront ES. There was a higher rate of peritoneal recurrence in SBTS group (27.4 vs 15.2% p = 0.034), with no difference observed in overall, liver or lung recurrences. No significant difference in overall survival (p = 0.11), cancer specific survival (p = 0.35), or recurrence free survival (p = 0.107) was observed. Univariate analysis showed that SBTS (OR 2.12, p = 0.036), diabetes mellitus (DM) (OR 2.58, p = 0.013), T4 (OR 2.81, p = 0.001), N + (OR 4.02, p = 0.001), lymphovascular invasion (OR 2.43, p = 0.011) contributed to a higher rate of peritoneal recurrence. Bivariate analysis showed synergistic relationship between T4 tumors and SBTS: in T4 tumors that underwent SBTS, the odds of having peritoneal recurrence was 6.8 times higher when compared to ES (p = 0.004); whilst in T2/3 tumors there was no significant difference observed (OR 1.33, p = 0.55). Multivariable analysis showed SBTS (OR 2.60, p = 0.04), DM (OR 2.88, p = 0.012), N + (OR 2.97, p = 0.026) were significant predictors for peritoneal recurrence. CONCLUSIONS There are concerns over oncological safety of SBTS even with low rates of stent-related perforation. Higher rates of peritoneal recurrence are seen especially with T4 colon cancers treated with SBTS. SBTS, DM and nodal stage were significant predictors for peritoneal recurrence.
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Affiliation(s)
- Wenjie Lin
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
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Ha GW, Lee MR. Short-term and long-term oncologic outcomes of self-expandable metallic stent compared with tube decompression for obstructive colorectal cancer: a systematic review and meta-analysis. Ann Surg Treat Res 2024; 106:93-105. [PMID: 38318094 PMCID: PMC10838655 DOI: 10.4174/astr.2024.106.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose Patients with obstructive colorectal cancer managed by emergency surgery show high morbidity, mortality, and stoma formation rates. Decompression modalities, including the self-expandable metallic stent (SEMS) and tube drainage (TD), have been used to improve surgical outcomes. However, there have been limited studies comparing the 2 modalities. We performed a meta-analysis on short- and long-term outcomes between SEMS and TD. Methods PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. Data were pooled, and the overall effect size was calculated using random effect models. Outcome measures were perioperative short-term and 3-year survival outcomes. Results We included 20 nonrandomized studies that examined 2,047 patients in the meta-analysis. The meta-analysis showed SEMS had better short-term outcomes in clinical success rate, decompression-related complications, laparoscopic surgery rate, stoma formation rate, and postoperative complication rate with a relative risk (RR) of 0.36 (95% confidence interval [CI], 0.24-0.54; I2 = 20%), 0.32 (95% CI, 0.20-0.50; I2 = 0%), 0.47 (95% CI, 0.34-0.66; I2 = 87%), 0.34 (95% CI, 0.24-0.49; I2 = 52%), and 0.70 (95% CI, 0.54-0.89, I2 = 28%), respectively. However, there was no significant difference between the 2 groups in 3-year overall survival (RR, 0.99; 95% CI, 0.77-1.27; I2 = 0%). Conclusion Although the long-term oncologic impact of SEMS is still unclear compared with TD, the results of this meta-analysis may suggest that SEMS insertion can be performed more successfully and safely and may have benefits for short-term perioperative outcomes compared with TD. Further studies are warranted to provide more definitive survival results.
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Affiliation(s)
- Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Canny JD, Johnston DB, McBrearty JA, McElvanna K, Caddy G, McKay D. The use of colonic stents as a bridge to surgery in malignant colonic obstruction - A dual trust experience over 10 years. THE ULSTER MEDICAL JOURNAL 2024; 92:134-138. [PMID: 38292498 PMCID: PMC10824134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction Worldwide colonic cancer is the third most common cancer with up to 30% of cases presenting with large bowel obstruction. Self-expanding metal stents (SEMS) have been used as a bridge to surgery (BTS) in the treatment of this malignant obstruction. We review the outcomes of SEMS as a BTS across two high volume colorectal units. Methodology A retrospective analysis of patients undergoing colonic stenting as a bridge to surgery was performed; outcomes were compared to previously published figures on emergency colonic resections. Inclusion criteria were adults (>18 years of age) undergoing colonic stenting for colonic obstruction with a view to elective resection. Patients undergoing stenting for palliation of symptoms were excluded. Results 39 patients were identified across both trusts over a ten-year period. 90 day mortality following BTS was found to be 3.6% and there was an 82.1% (32/39) technical success rate. 46.4% proceeded to an elective resection which was started laparoscopically. Permanent stoma rate was observed at 14.3% for elective surgery. Conclusion Stenting for relief of acute malignant obstruction as a bridge to surgery is a viable option in select patients. Further research is required to determine oncological safety and rate of local recurrences.
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Affiliation(s)
- J D Canny
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | - D B Johnston
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | | | | | - G Caddy
- Ulster Hospital, Dundonald, South Eastern HSC Trust
| | - D McKay
- Craigavon Area Hospital, Southern HSC Trust
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Numata K, Numata M, Shirai J, Sawazaki S, Okamoto H, Godai T, Katayama Y, Atsumi Y, Kazama K, Uchiyama M, Kohmura T, Mushiake H, Sugano N, Higuchi A, Kato A, Iguchi K, Rino Y, Shiozawa M. Short- and long-term outcomes of transanal decompression tube and self-expandable metallic stent for obstructive colorectal cancer based on a multicenter database (KYCC2110). J Surg Oncol 2023; 128:1372-1379. [PMID: 37753717 DOI: 10.1002/jso.27454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
AIM There are well-known methods for decompressing the colorectal tract before surgery, including transanal decompression tubes (TDT) and self-expanding metallic stents (SEMS). This study aimed to compare the short and long-term results in patients with malignant large bowel obstruction in whom TDT or SEMS were placed before surgery. METHODS This retrospective observational study enrolled 225 patients with malignant large bowel obstruction in whom TDT or SEMS were placed preoperatively and underwent R0 resection between 2008 and 2020. One-to-two propensity score matching was performed according to patient characteristics. Short- and long-term outcomes were compared. The primary endpoint was relapse-free survival (RFS). The secondary endpoints were the overall survival (OS) and postoperative complication rate. RESULTS Fifty-seven patients in the TDT group and 114 in the SEMS group were matched. The 3-year RFS rates were 66.7% in the TDT group and 69.9% in the SEMS group (p = 0.54), and the 3-year OS rates were 90.5% in the TDT group and 87.1% in the SEMS group (p = 0.52). No significant differences in the long-term results were observed between the two groups. Regarding short-term results, the SEMS group had significantly fewer stoma construction (p = 0.007) and shorter postoperative hospitalization (p < 0.001). The incidence of postoperative complications (grade ≥ 2) was significantly lower in the SEMS group (p = 0.04). CONCLUSION No significant differences in the long-term results were observed between the TDT and SEMS group. The SEMS showed significant usefulness in terms of improving short-term outcomes.
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Affiliation(s)
- Koji Numata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masakatsu Numata
- Department of Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Junya Shirai
- Department of Surgery, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hironao Okamoto
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Teni Godai
- Department of Surgery, Fujisawa Shounandai Hospital, Fujisawa, Japan
| | - Yusuke Katayama
- Department of Surgery, Hadano Red Cross Hospital, Hadano, Japan
| | - Yosuke Atsumi
- Department of Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Mamoru Uchiyama
- Department of Surgery, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Japan
| | - Takashi Kohmura
- Department of Surgery, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Akio Higuchi
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Aya Kato
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Kenta Iguchi
- Department of Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
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Zhou XC, Ke FY, Dhamija G, Viroja RD, Huang CW. Application of metal stent implantation with endoscope and X-ray fluoroscopy combined laparoscopic surgery in the treatment of acute left hemicolon cancer obstruction. World J Surg Oncol 2023; 21:331. [PMID: 37865772 PMCID: PMC10589989 DOI: 10.1186/s12957-023-03228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND This study aimed to conduct a case-control study of endoscopic and fluoroscopic metal stent placement combined with laparoscopic surgery versus conventional open Hartmann's procedure in treating acute left-sided colon cancer obstruction. Additionally, the study aims to discuss the application value of endoscopic and X-ray-guided metal stent placement combined with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. METHODS From June 2011 to December 2019, 23 patients with acute left-sided colon cancer obstruction who underwent metal stent implantation combined with laparoscopic surgery under endoscopy and X-ray fluoroscopy in Wenzhou Central Hospital were collected, and 20 patients with acute left-sided colon cancer obstruction who underwent traditional emergency open Hartmann's surgery during the same period were selected as a control group. All patients were diagnosed with left colon obstruction by plain abdominal film and/or CT before the operation and colon adenocarcinoma by colonoscopic biopsy and/or postoperative pathology. The operation time, intraoperative blood loss, postoperative anal exhaust time, the success rate of one-stage anastomosis, postoperative hospital stay, and postoperative complications were compared between the two groups. RESULTS This study showed a significant difference in the therapeutic effect between the two groups. Compared with the traditional Hartmann's operation group, the success rate of one-stage anastomosis in endoscopic and X-ray-guided metal stent placement combined with the laparoscopic operation group was significantly higher than that in the Hartmann's operation group (P < 0.05). The overall incidence of postoperative complications and hospital stay were significantly lower in the observation group than in the Hartmann's group (P < 0.05). Further subgroup analysis of the overall postoperative complication rate of the two groups showed that the traditional Hartmann's operation group was more likely to have an incomplete intestinal obstruction (P < 0.05). This study also showed no significant differences between the two groups in operation time, intraoperative blood loss, number of harvested lymph nodes, and postoperative anal exhaust time (all P > 0.05). This study also found no significant differences between the two groups in overall survival rates or recurrence-free survival rates (all P > 0.05). CONCLUSIONS The comparison of the therapeutic effects of the two groups verified the feasibility of endoscopy combined with X-ray fluoroscopy metal stent placement in combination with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. Compared with the traditional emergency open Hartmann's procedure, metal stent implantation under endoscopy and X-ray fluoroscopy combined with laparoscopic surgery is more minimally invasive, safe, and effective. It avoids the traditional second or even third surgical trauma to effectively improve the quality of life of patients, so that patients can recover quickly after surgery.
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Affiliation(s)
- Xiao-Cong Zhou
- Department of Colorectal Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, People's Republic of China
| | - Fei-Yue Ke
- Postgraduate Training Base Alliance of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, People's Republic of China
| | - Gaurav Dhamija
- School of International Studies, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ruchi D Viroja
- School of International Studies, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chun-Wei Huang
- Department of Gastroenterology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), No.252, Baili East Road, 325000, Wenzhou, Zhejiang, People's Republic of China.
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M, the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. AIM The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. MATERIAL AND METHODS The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. RESULTS AND CONCLUSIONS There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Mäder M, Kalt F, Schneider M, Kron P, Ramser M, Lopez-Lopez V, Biondo S, Faucheron JL, Yoshiyuki S, von der Groeben M, Novak A, Teufelberger G, Lehmann K, Eshmuminov D. Self-expandable metallic stent as bridge to surgery vs. emergency resection in obstructive right-sided colon cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:265. [PMID: 37402932 DOI: 10.1007/s00423-023-02979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Emergency resection is common for malignant right-sided obstructive colon cancer. As there is evidence showing a potential benefit of self-expandable metal stents as a bridge to surgery, a new debate has been initiated. OBJECTIVE The aim of this study was to compare self-expandable metal stents with emergency resection in right-sided obstructive colon cancer. DATA SOURCE A systematic search was conducted accessing Medline/PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews. STUDY SELECTION Studies reporting either emergency surgery or stent placement in right-sided obstructive colon cancer were included. INTERVENTION Stent or emergency resection in right-sided obstructive colon cancer. MAIN OUTCOME MEASURES Morbidity rate, mortality rate, stoma rate, laparoscopic resection rate, anastomotic insufficiency rate, success rate of stent. RESULTS A total of 6343 patients from 16 publications were analyzed. The stent success rate was 0.92 (95% CI, 0.87 to 0.95) with perforation of 0.03 (95% CI, 0.01 to 0.06). Emergency resection was performed laparoscopically at a rate of 0.15 (95% CI, 0.09 to 0.24). Primary anastomosis rate in emergency resection was 0.95 (95% CI, 0.91 to 0.97) with an anastomotic insufficiency rate of 0.07 (95% CI, 0.04 to 0.11). The mortality rate after emergency resection was 0.05 (95% CI, 0.02 to 0.09). Primary anastomosis and anastomotic insufficiency rate were similar between the two groups (RR: 1.02; 95% CI, 0.95 to 1.1; p = 0.56 and RR: 0.53; 95% CI, 0.14 to 1.93; p = 0.33). The mortality rate in emergency resection was higher compared to stent (RR: 0.51, 95% CI 0.30 to 10.89, p = 0.016). LIMITATION No randomized controlled trials are available. CONCLUSION Stent is a safe and successful alternative to emergency resection and may increase the rate of minimally invasive surgery. Emergency resection, however, remains safe and did not result in higher rate of anastomotic insufficiency. Further high-quality comparative studies are warranted to assess long-term outcomes.
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Affiliation(s)
- Mirjam Mäder
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | - Fabian Kalt
- Department of General Surgery, Hospital Muri, Muri, Switzerland
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marcel Schneider
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Kron
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Ramser
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Victor Lopez-Lopez
- Department of Surgery and Transplantation, IMIB-Arrixaca, Virgen de La Arrixaca Clinic and University, Murcia, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Jean-Luc Faucheron
- Department of Surgery, Grenoble Alps University Hospital, Grenoble, France
| | - Suzuki Yoshiyuki
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | | | - Allan Novak
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | | | - Kuno Lehmann
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | - Dilmurodjon Eshmuminov
- Department of General Surgery, Hospital Muri, Muri, Switzerland.
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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14
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Matsuda A, Yamada T, Yokoyama Y, Takahashi G, Yoshida H. Long-term outcomes between self-expandable metallic stent and transanal decompression tube for malignant large bowel obstruction: A multicenter retrospective study and meta-analysis. Ann Gastroenterol Surg 2023; 7:583-593. [PMID: 37416739 PMCID: PMC10319605 DOI: 10.1002/ags3.12664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 07/08/2023] Open
Abstract
AIM To compare the oncological outcomes between self-expandable metallic stent (SEMS) as a bridge to surgery and transanal decompression tube (TDT) placement for malignant large bowel obstruction (MLBO). METHODS A total of 287 MLBO patients who underwent SEMS (n = 137) or TDT placement (n = 150) were enrolled in this multicenter retrospective study. Overall survival (OS) and disease-free survival (DFS) between the two groups were compared. A meta-analysis was performed using random-effects models to calculate odd ratios (OR) with 95% confidence intervals (CIs). RESULTS Postoperative complications of Clavien-Dindo grade ≥II and ≥III occurred frequently in the TDT group compared with the SEMS group (P = 0.002 and 0.005, respectively). The 3-y OS in the overall cohort and 3-y DFS in the pathological stage II/III cohort in the SEMS and TDT groups were 68.6% and 71.4%, and 71.0% and 72.6%, respectively. The survival differences were not significantly different in the OS and DFS analyses (P = 0.819 and P = 0.892, respectively). A meta-analysis of nine studies (including our cohort data) demonstrated no significant difference between the SEMS and TDT groups for 3-y OS and DFS (OR = 0.96, 95% CI = 0.57-1.62, P = 0.89 and OR = 0.69, 95% CI = 0.46-1.04, P = 0.07, respectively). CONCLUSION Our study demonstrated that SEMS placement had no inferiority regarding long-term outcomes, including OS and DFS, compared with TDT placement. Considering the short-term benefits of SEMS placement, this could be a preferable preoperative decompression method for MLBO.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Yasuyuki Yokoyama
- Department of Digestive SurgeryNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
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Dosis A, Helliwell J, Syversen A, Tiernan J, Zhang Z, Jayne D. Estimating postoperative mortality in colorectal surgery- a systematic review of risk prediction models. Int J Colorectal Dis 2023; 38:155. [PMID: 37261539 DOI: 10.1007/s00384-023-04455-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Risk prediction models are frequently used to support decision-making in colorectal surgery but can be inaccurate. Machine learning (ML) is becoming increasingly popular, and its application may increase predictive accuracy. We compared conventional risk prediction models for postoperative mortality (based on regression analysis) with ML models to determine the benefit of the latter approach. METHODS The study was registered in PROSPERO(CRD42022364753). Following the PRISMA guidelines, a systematic search of three databases (MEDLINE, EMBASE, WoS) was conducted (from 1/1/2000 to 29/09/2022). Studies were included if they reported the development of a risk model to estimate short-term postoperative mortality for patients undergoing colorectal surgery. Discrimination and calibration performance metrics were compared. Studies were evaluated against CHARMS and TRIPOD criteria. RESULTS 3,052 articles were screened, and 45 studies were included. The total sample size was 1,356,058 patients. Six studies used ML techniques for model development. Most studies (n = 42) reported the area under the receiver operating characteristic curve (AUROC) as a measure of discrimination. There was no significant difference in the mean AUROC values between regression models (0.833 s.d. ± 0.52) and ML (0.846 s.d. ± 0.55), p = 0.539. Calibration statistics, which measure the agreement between predicted estimates and observed outcomes, were less consistent. Risk of bias assessment found most concerns in the data handling and analysis domains of eligible studies. CONCLUSIONS Our study showed comparable predictive performance between regression and ML methods in colorectal surgery. Integration of ML in colorectal risk prediction is promising but further refinement of the models is required to support routine clinical adoption.
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Affiliation(s)
| | | | | | - Jim Tiernan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Chok AY, Zhao Y, Lim HJ, Ng YYR, Tan EJKW. Stenting as a bridge to surgery in obstructing colon cancer: Long-term recurrence pattern and competing risk of mortality. World J Gastrointest Endosc 2023; 15:64-76. [PMID: 36925648 PMCID: PMC10011892 DOI: 10.4253/wjge.v15.i2.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC) has been associated with possibly worse oncological outcomes.
AIM To evaluate the recurrence patterns, survival outcomes, and colorectal cancer (CRC)-specific death in patients undergoing SBTS for OCC.
METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined. Primary outcomes were recurrence patterns, overall survival (OS), cancer-specific survival (CSS), and CRC-specific death. OS and CSS were estimated using the Kaplan-Meier curves. Competing risk analysis with cumulative incidence function (CIF) was used to estimate CRC-specific mortality with other cause-specific death as a competing event. Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death. Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.
RESULTS 28 patients (45.2%) developed metastases after a median period of 16 mo. Among the 18 patients with single-site metastases: Four had lung-only metastases (14.3%), four had liver-only metastases (14.3%), and 10 had peritoneum-only metastases (35.7%), while 10 patients had two or more sites of metastatic disease (35.7%). The peritoneum was the most prevalent (60.7%) site of metastatic involvement (17/28). The median follow-up duration was 46 mo. 26 (41.9%) of the 62 patients died, of which 16 (61.5%) were CRC-specific deaths and 10 (38.5%) were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%; 1-, 3-, and 5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mo was liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictive of CRC-specific death.
CONCLUSION The peritoneum was the most common metastatic site among patients undergoing SBTS. Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors of CRC-specific death.
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Affiliation(s)
- Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Department of Group Analytics, Singapore Health Services, Singapore 168582, Singapore
| | - Hui Jun Lim
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yvonne Ying Ru Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
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Khomvilai S, Pattarajierapan S. Comparison of long-term outcomes of colonic stenting as a "bridge to surgery" and emergency surgery in patients with left-sided malignant colonic obstruction. Ann Coloproctol 2023; 39:17-26. [PMID: 34324803 PMCID: PMC10009074 DOI: 10.3393/ac.2021.00227.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Long-term oncologic outcomes of colonic stenting as a "bridge to surgery" in patients with left-sided malignant colonic obstruction (LMCO) are unclear. This study was performed to compare long-term outcomes of self-expandable metal stent (SEMS) insertion as a bridge to surgery and emergency surgery in patients with acute LMCO. METHODS This retrospective cohort study included patients with acute LMCO who underwent SEMS insertion as a bridge to surgery or emergency surgery. The primary outcomes were 5-year disease-free survival (DFS), overall survival (OS), and recurrence rate. Survival outcomes were determined using the Kaplan-Meier method and compared using log-rank tests. RESULTS There was a trend of worsening 5-year OS rate in the SEMS group compared with emergency surgery group (45% vs. 57%, P=0.07). In stage-wise subgroup analyses, a trend of deteriorating 5-year OS rate in the SEMS group with stage III (43% vs. 59%, P=0.06) was observed. The 5-year DFS and recurrence rate were not different between groups. The overall median follow-up time was 58 months. On multivariate analysis, age of ≥65 years and American Joint Committee on Cancer stage of ≥III, and synchronous metastasis were significant poor prognostic factors for OS (hazard ratio [HR], 1.709; 95% confidence interval [CI], 1.007-2.900; P=0.05/HR, 1.988; 95% CI, 1.038-3.809; P=0.04/HR, 2.146; 95% CI, 1.191-3.866; P=0.01; respectively). CONCLUSION SEMS as a bridge to surgery may have adverse oncologic outcomes. Patients in the SEMS group had a trend of worsening 5-year OS rate without higher recurrence.
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Affiliation(s)
- Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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A retrospective evaluation of short-term results from colonic stenting as a bridge to elective surgery versus emergency surgery for malignant colonic obstruction. Sci Rep 2023; 13:1600. [PMID: 36709359 PMCID: PMC9884234 DOI: 10.1038/s41598-023-28685-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
The efficacy and safety of self-expanding metallic stent (SEMS) placement as a bridge to elective surgery versus emergency surgery to treat malignant colonic obstruction is debated. This study aimed to evaluate the outcomes of patients with malignant colonic obstruction treated using different procedure. Subjects admitted to the authors' department with colonic obstruction (n = 87) were studied. They underwent colonic stenting as a bridge to elective surgery (SEMS group: n = 14) or emergency surgery (ES group: n = 22).Their demographic characteristics, stoma rate, laparoscopy rate and postoperative complications were analyzed, and the potential risk factors of postoperative complications and the optimal time interval from SEMS implantation to elective surgery were explored. The stoma rate was 15.4% in the SEMS group versus 60.0% in the ES group (P = 0.015), and the postoperative complication rate was 7.7% in the SEMS group versus 40.0% in the ES group (P = 0.042). The proportion of patients undergoing laparoscopy in SEMS group was significantly higher than that in ES group (69.2% vs. 15.0%; P = 0.003).The effect of ASA grade on postoperative complications was statistically significant (OR = 24.565; P = 0.008). The Receiving operating characteristic (ROC) curve could not determine the optimal time interval between SEMS implantation and elective surgery (AUC = 0.466). SEMS implantation has the advantages of lower temporary stoma rate, less postoperative complications and higher laparoscopy rate compared with ES in the treatment of left malignant intestinal obstruction. ASA grade is a risk factor for postoperative complications. However, larger sample size prospective randomized controlled trials (RCT) are still needed to confirm long-term oncological outcomes.
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19
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Zaafouri H, Cherif M, Khedhiri N, Mesbahi M, Zebda H, Jouini R, Bellali H, Ben Maamer A. EMERGENCY SURGERY FOR OBSTRUCTING COLON CANCER: MORBIDITY AND RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY - A COHORT STUDY OF 118 CASES. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1706. [PMID: 36629687 PMCID: PMC9831636 DOI: 10.1590/0102-672020220002e1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10-27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. AIMS The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. METHODS A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission). RESULTS In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. CONCLUSION This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.
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Affiliation(s)
- Haithem Zaafouri
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
| | - Mona Cherif
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
| | - Nizar Khedhiri
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
| | - Meryam Mesbahi
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
| | - Helmo Zebda
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
| | - Raja Jouini
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, Cytopathology - Tunis
| | - Hedia Bellali
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, Epidemiology and Public Health - Tunis
| | - Anis Ben Maamer
- University Tunis El Manar, Faculty of Medicine of Tunis, Habib Thameur Hospital, General Surgery - Tunis
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20
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Pattarajierapan S, Sukphol N, Junmitsakul K, Khomvilai S. Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects. World J Clin Oncol 2022; 13:943-956. [PMID: 36618077 PMCID: PMC9813833 DOI: 10.5306/wjco.v13.i12.943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 12/19/2022] Open
Abstract
Approximately 7%-29% of patients with colorectal cancer present with colonic obstruction. The concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS) is appealing. However, concerns on colonic stenting possibly impairing oncologic outcomes have been raised. This study aimed to review current evidence on the short- and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction. For short-term outcomes, colonic stenting facilitates a laparoscopic approach, increases the likelihood of primary anastomosis without a stoma, and may decrease postoperative morbidity. However, SEMS-related perforation also increases local recurrence and impairs overall survival. Moreover, colonic stenting may cause negative oncologic outcomes even without perforation. SEMS can induce shear forces on the tumor, leading to increased circulating cancer cells and aggressive pathological characteristics, including perineural and lymphovascular invasion. The conflicting evidence has led to discordant guidelines. Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research (e.g., alteration of circulating tumors) are needed to clarify the actual benefit of colonic stenting as BTS.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nattapanee Sukphol
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Karuna Junmitsakul
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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21
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Delson D, Ward M, Haddock R, Nobes J, Digby J, Strachan JA, Mowat C. Impact of faecal haemoglobin based triage of bowel symptoms presenting to primary care on colorectal cancer diagnosis. Colorectal Dis 2022; 25:787-793. [PMID: 36495081 DOI: 10.1111/codi.16451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 12/30/2022]
Abstract
AIM Faecal immunochemical testing (FIT) for faecal haemoglobin was introduced into primary care in National Health Service Tayside in 2015 as an adjunct to clinical assessment of new bowel symptoms. We aimed to assess the impact of FIT-based triage in primary care on colorectal cancer (CRC) diagnosis. METHOD Cancer audit data between January 2016 and December 2019 were reviewed to identify all patients diagnosed locally with CRC. The mode of presentation and stage at diagnosis were noted and patient records were interrogated to identify whether FIT and full blood count (FBC) had been performed prior to referral. Results were compared between the FIT and non-FIT groups. RESULTS In all, 1245 patients were diagnosed with CRC of whom 581 (46.7%) presented through primary care. FIT was performed prior to referral in 440/581 (75.7%), with the proportion increasing from 62.3% in 2016 to 85.8% in 2019. At faecal haemoglobin ≥10 μg Hb/g faeces, sensitivity for CRC was 94.1%. Over the study period the annual proportion of non-emergency presentations increased significantly; presentations from primary care increased from 43.1% to 53.5% (P = 0.0096). After excluding non-FIT patients who had an overt CRC at referral, there was no difference in stage at diagnosis between FIT and non-FIT cancers. Safety-netting with FBC was widely used in our cohort with 97.3% of FIT patients having also had FBC. CONCLUSION FIT-based triage of new bowel symptoms in primary care is associated with increased non-emergency presentation of CRC but this did not influence stage at diagnosis.
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Affiliation(s)
- Dwi Delson
- School of Medicine, University of Dundee, Dundee, UK
| | - Mark Ward
- School of Medicine, University of Dundee, Dundee, UK
| | | | - Jennifer Nobes
- School of Medicine, University of Dundee, Dundee, UK.,Department of Blood Sciences, Ninewells Hospital, Dundee, UK
| | - Jayne Digby
- School of Medicine, University of Dundee, Dundee, UK
| | - Judith A Strachan
- School of Medicine, University of Dundee, Dundee, UK.,Department of Blood Sciences, Ninewells Hospital, Dundee, UK
| | - Craig Mowat
- School of Medicine, University of Dundee, Dundee, UK.,Department of Gastroenterology, Ninewells Hospital, Dundee, UK
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22
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Zarnescu EC, Zarnescu NO, Sanda N, Costea R. Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy: Unicenter Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1598. [PMID: 36363555 PMCID: PMC9697206 DOI: 10.3390/medicina58111598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 08/30/2023]
Abstract
Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods: All consecutive patients with right colon cancer who underwent right colectomy in our department between 2016 and 2021 were retrospectively included in this study. The Clavien-Dindo grading system was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyses were used to investigate risk factors for postoperative severe complications. Results: Of the 144 patients, there were 69 males and 75 females, with a median age of 69 (IQR 60-78). Postoperative morbidity and mortality rates were 41.7% (60 patients) and 11.1% (16 patients), respectively. The anastomotic leak rate was 5.3% (7 patients). Severe postoperative complications (Clavien-Dindo grades III-V) were present in 20 patients (13.9%). Univariate analysis showed the following as risk factors for postoperative severe complications: Charlson score, lack of mechanical bowel preparation, level of preoperative proteins, blood transfusions, and degree of urgency (elective/emergency right colectomy). In the logistic binary regression, the Charlson score (OR = 1.931, 95% CI = 1.077-3.463, p = 0.025) and preoperative protein level (OR = 0.049, 95% CI = 0.006-0.433, p = 0.007) were found to be independent risk factors for postoperative severe complications. Conclusions: Severe complications after oncologic right colectomy are associated with a low preoperative protein level and a higher Charlson comorbidity index.
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Affiliation(s)
- Eugenia Claudia Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Narcis Octavian Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Nicoleta Sanda
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Radu Costea
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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23
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Iboshi Y, Sumida Y, Ihara E, Fujii H, Harada N, Nakamuta M, Ogawa Y. Over-the-catheter endoscope replacement for stenting in patients with inaccessible malignant colonic obstruction with coexisting peritoneal carcinomatosis. Dig Endosc 2022; 34:1481-1490. [PMID: 35735272 PMCID: PMC9804792 DOI: 10.1111/den.14385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 01/09/2023]
Abstract
Although a large-caliber endoscope (LCE) is indispensable for through-the-scope placement of a self-expandable metallic stent (SEMS) in patients with malignant colonic obstruction (MCO), inaccessibility of the target obstructing lesion (TOL) by the endoscope is a significant cause of unsuccessful procedures. We herein present a novel salvage procedure when the TOL is not directly accessible by an LCE in conditions such as coexisting peritoneal carcinomatosis involving the colon. The salvage procedure, termed over-the-catheter endoscope replacement (OCER), starts with an ultraslim endoscope suitable for deep insertion beyond a tortuous colon for traversing a guidewire through the TOL. The ultraslim endoscope is then withdrawn and replaced by an LCE through the following steps. An endoscopic retrograde cholangiopancreatography catheter is preloaded in the LCE, the catheter alone is passed over the guidewire already traversed through the TOL, and the LCE is navigated over the catheter as far as possible toward the TOL to deliver the SEMS delivery system in a standard through-the-scope manner or further in an over-the-wire manner even if LCE insertion is incomplete. Among the 165 patients with MCO who underwent stenting during our study period, OCER led to successful procedures in all nine patients whose TOLs were initially inaccessible because of colon-involving peritoneal carcinomatosis. By utilizing the functions of distinctive endoscopes in a unique and complementary way, OCER can be a practical salvage option for challenging cases of MCO that are highly prone to unsuccessful palliation by conventional SEMS placement.
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Affiliation(s)
- Yoichiro Iboshi
- Department of GastroenterologyClinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Yorinobu Sumida
- Department of GastroenterologyClinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Hiroyuki Fujii
- Department of Gastroenterology and HepatologyNational Hospital Organization Fukuokahigashi Medical CenterFukuokaJapan
| | - Naohiko Harada
- Department of GastroenterologyClinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Makoto Nakamuta
- Department of GastroenterologyClinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
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24
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Muacevic A, Adler JR, Aker M, Eltyeb HA, Green S. Impact of COVID-19 on the Mode of Presentation and Stage at Diagnosis of Colorectal Cancer. Cureus 2022; 14:e32037. [PMID: 36600813 PMCID: PMC9801339 DOI: 10.7759/cureus.32037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
AIM This study compares the stage at the presentation of patients with colorectal cancer (CRC) before and after introducing COVID-19 restrictions and the mode of presentation. METHODS This is a retrospective cohort study comparing the incidence of CRC, TNM stage and mode of presentation in the pre-COVID and COVID cohorts at a single UK Trust. All patients discussed at the CRC multidisciplinary team (MDT) from March 2017 to March 2021 were included and split into two cohorts; the pre-COVID group from 01/03/2017 to 29/02/2020 and the COVID group from 01/03/2020 to 28/02/2021. Percentages were used for descriptive statistics. Student's t-test was used for the comparison of demographic variables. Chi-squared test was used for the difference analysis for the categorical data, such as TNM and mode of presentation. P value ≤0.05 was significant. RESULTS In total, 1373 patients were diagnosed with CRC during the period from March 2017 to March 2021. The pre-COVID group (2017-2020) included 1104 CRC patients, compared to 269 patients in the COVID one (2020-2021). The mean age was higher in the pre-COVID group (p = 0.001). There was a statistically significant increase in the proportion of cases presenting with T4 disease (p = 0.023) and metastatic disease (p = 0.032) in the COVID group compared to the pre-COVID group. There was also a significant increase in the rate of emergency presentations (p < 0.0001). CONCLUSION We observed a statistically significant increase in rates of locally advanced (T4) and metastatic (distant) CRC in patients presenting after introducing the COVID-19 lockdown. There was also an increase in emergency presentations. There was no observed difference in nodal status. This may reflect disruption to cancer diagnostic services and the reluctance of patients to access medical care during a pandemic, particularly the elderly.
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25
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Mihailov R, Firescu D, Constantin GB, Mihailov OM, Hoara P, Birla R, Patrascu T, Panaitescu E. Mortality Risk Stratification in Emergency Surgery for Obstructive Colon Cancer-External Validation of International Scores, American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC), and the Dedicated Score of French Surgical Association (AFC/OCC Score). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13513. [PMID: 36294094 PMCID: PMC9603747 DOI: 10.3390/ijerph192013513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The increased rates of postoperative mortality after emergency surgery for obstructive colon cancer (OCC) require the use of risk-stratification scores. The study purpose is to external validate the surgical risk calculator (SRC) and the AFC/OCC score and to create a score for risk stratification. PATIENTS AND METHODS Overall, 435 patients with emergency surgery for OCC were included in this retrospective study. We used statistical methods suitable for the aimed purpose. RESULTS Postoperative mortality was 11.72%. SRC performance: strong discrimination (AUC = 0.864) and excellent calibration (11.80% predicted versus 11.72% observed); AFC/OCC score performance: adequate discrimination (AUC = 0.787) and underestimated mortality (6.93% predicted versus 11.72% observed). We identified nine predictors of postoperative mortality: age > 70 years, CHF, ECOG > 2, sepsis, obesity or cachexia, creatinine (aN) or platelets (aN), and proximal tumors (AUC = 0.947). Based on the score, we obtained four risk groups of mortality rate: low risk (0.7%)-0-2 factors, medium risk (12.5%)-3 factors, high risk (40.0%)-4 factors, very high risk (84.4%)-5-6 factors. CONCLUSIONS The two scores were externally validated. The easy identification of predictors and its performance recommend the mortality score of the Clinic County Emergency Hospital of Galați/OCC for clinical use.
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Affiliation(s)
- Raul Mihailov
- Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania
| | - Dorel Firescu
- Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania
| | | | | | - Petre Hoara
- General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
| | - Rodica Birla
- General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
| | - Traian Patrascu
- General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, Carol Davila University, 050474 Bucharest, Romania
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26
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CReST Collaborative Group, Hill J, Lee S, Morton D, Parker M, Halligan S, Taylor S, Kay C, Gray R, Handley K, Kaur M, Magill L, Fulcher L, Kaur M, Lilly H, Palmer A, Peters A, Magill L, Sidile C, Wilcockson A, Bensoussane H, Handley K, Marchevsky N, Oliver A, Carlson G, Scott N, Hiller L, Alderson D, Martin D, Yu L, Chokkalingam A, Cross N, Delicata RJ, Edwards P, Sturgeon G, Domingo D, Gutmann J, Huang J, Mills-Baldock T, Mtwana A, Premchand P, Willis N, Cocks S, Curran E, Gall Z, Harris P, Hobbiss J, Lipscomb G, Maxwell A, Patel H, Smith D, Antrum RM, Beckett CG, Davies J, Ghosh T, Gokhale J, Griffith JP, Halstead J, Jackson C, Jowett S, Kay C, Lowe A, May J, McGowan J, Robinson J, Simpson R, Stephenson S, Steward M, Thomas B, Thrower A, Ward K, Dexter J, Doyle T, Farrands P, Hart A, Lamah M, Peterson J, Brown H, Cameron E, Carroll N, Davies J, Fearnhead N, Goodwin K, Liddle A, Miller R, Morton J, Powar M, Read D, Sloan K, Uttridge J, Wheeler J, Bain I, Clark S, Cundall J, Dent J, Green S, Grunshaw N, Gunning K, Howey A, Marsden S, et alCReST Collaborative Group, Hill J, Lee S, Morton D, Parker M, Halligan S, Taylor S, Kay C, Gray R, Handley K, Kaur M, Magill L, Fulcher L, Kaur M, Lilly H, Palmer A, Peters A, Magill L, Sidile C, Wilcockson A, Bensoussane H, Handley K, Marchevsky N, Oliver A, Carlson G, Scott N, Hiller L, Alderson D, Martin D, Yu L, Chokkalingam A, Cross N, Delicata RJ, Edwards P, Sturgeon G, Domingo D, Gutmann J, Huang J, Mills-Baldock T, Mtwana A, Premchand P, Willis N, Cocks S, Curran E, Gall Z, Harris P, Hobbiss J, Lipscomb G, Maxwell A, Patel H, Smith D, Antrum RM, Beckett CG, Davies J, Ghosh T, Gokhale J, Griffith JP, Halstead J, Jackson C, Jowett S, Kay C, Lowe A, May J, McGowan J, Robinson J, Simpson R, Stephenson S, Steward M, Thomas B, Thrower A, Ward K, Dexter J, Doyle T, Farrands P, Hart A, Lamah M, Peterson J, Brown H, Cameron E, Carroll N, Davies J, Fearnhead N, Goodwin K, Liddle A, Miller R, Morton J, Powar M, Read D, Sloan K, Uttridge J, Wheeler J, Bain I, Clark S, Cundall J, Dent J, Green S, Grunshaw N, Gunning K, Howey A, Marsden S, Minty I, Morgan L, Noblett S, Potts K, Scott J, Turnbull D, Varma JS, Wayman L, Welsh S, Anstead A, Bhardwaj R, Edmunds T, Fuller B, Holder P, Lacey L, Parker MC, Ryan R, Smith-Hedges J, Stuart C, Walsh K, Basu A, Omar A, Pitt J, Read G, Ridley P, Spurgeon J, Tricker Y, Bird N, Browell D, Barry C, Cunliffe W, Eltringham M, Katrory M, Mercer-Jones M, Nice C, Scott J, Timmons G, Williams M, Wipat C, Akula J, Caine A, Dawson P, Reese G, Fatola Y, Mazibuko B, Pelling M, Ramos L, Smith GV, Aryal K, Ashraf K, Badreldin R, Brett B, DeSilva A, Gray S, Harman J, Jordon M, Kshatriya KS, Lal R, Perry L, Velchuru V, Williams M, Chung-Faye G, Hansmann A, Leather A, Papagrigoriadis S, Peddu P, Ryan S, Ambrose S, Baker R, Beral D, Botterill I, Burke D, Clarke L, Evans M, Everett S, Finan PJ, Griffiths B, Hamlin J, Hance J, Harris K, Hussain M, Jayne D, Kelly S, Lim M, Maslekar S, Miskovic D, Moriarty C, Priestley M, Rawson S, Sagar PM, Saunders R, Sheridan M, Speight H, Tolan D, White L, Wilkinson L, Wilson T, Burling D, Clark S, Datt P, Fraser C, Gupta A, Jenkins I, Kennedy R, Northover JM, Sakuma S, Saunders BP, Suzuki N, Thomas-Gibson S, Curran F, Hitchen D, Immanuel A, Kirk S, Kushwaha R, Lee S, Parker M, Vanessa A, Butler-Barnes J, Hough C, Khan A, Larcombe T, London I, Selvasekar C, Zaman S, Anderson J, Ball J, Basheer M, Brittenden J, Fawole A, Foster R, Gill K, Hayton-Bott A, Jones A, Kamposioras K, Kerr S, Lowry T, Lupton S, Macklin C, Morrison C, Morrison CP, Narula H, Parchment-Smith C, Rogers M, Shah S, Sivakumar R, Sivaramakrishnan N, Vani D, Verma K, Sivanathan C, Chong P, Duff M, Duffey K, Horgan P, McGregor L, McKee R, Pender J, Viswanathan S, Ashcroft M, Docherty JG, Donaldson A, Lim M, Macleod K, Macleod AJM, Todd A, Walker KG, Watson AJM, Younger H, Brush J, Glancy S, MacRury M, Mander J, Paterson H, Atkin L, Brain C, Brunt S, Burt C, Cheshire H, Clout M, Corderoy H, Dawe C, Dixon AR, Garlicka H, Hopes M, John S, Kirby K, Kirkpatrick S, Law R, Longstaff A, Loveday E, Lyons A, McCarthy K, Pullyblank A, Reilly A, Richmond-Russell K, Roe AM, Saville L, Shelton L, Slack N, Smith C, Solomon L, Treasure A, Agarwal AK, Borowski D, Chilvers A, Dwarakanath D, Essex S, Garg D, Gill T, Jameson E, Jones-King P, Kiddell S, Latif H, Latimer J, Shepherd L, Sinclair S, Tabaqchali MA, Wardle H, Wilson D, Ahmad A, Arain A, Cartmell M, Cross K, Davis A, Groome J, Holbrook B, Ley S, Markham N, Menon M, Taylor J, Thomas F, Koutrik LV, Ahmad SM, Cursley V, Dent K, Martin K, Pai D, Pearson S, Abercrombie JF, Acheson A, Aldred L, Armitage NC, Banerjea A, Coulson C, Eyre M, Maxwell-Armstrong CA, O'Neil R, Ragunath K, Robinson MHE, Scholefield JH, Swinden R, Williams J, Anthony S, Bratby M, Cunningham C, Fourie S, Jones O, Lindsey I, Morrison F, Mortensen NJ, Munday D, Uberoi R, Ahmad F, Chandra N, Conaghan P, Coull D, Foxton J, Gibson M, Hameed W, Jones L, McGrath D, Ramus J, Samakomva T, Speirs A, Walsh K, Arumugam H, Ewiddison A, Faux W, Feldman M, Gopalswamy S, Graves L, Hancock J, Harvey P, Hussaini H, Lloyd-Davies E, Lynn C, Madine JP, Maskell G, Morley N, Pollard K, Prout K, Boorman P, Dickinson B, Guinness R, Hill T, Moran J, Anderson ID, Ashton A, Babbs C, Burnett H, Goulden K, Harrison P, Harter L, Hughes S, Kenyon V, Lee S, Lees N, Lydon A, Ogden A, Ottiwell L, Platt D, Read F, Slade D, Thompson C, Vinod C, Watson D, Brown S, Donnelly D, Hampton J, Eyre-Brook IA, Foot J, Forsyth N, Hunt L, Lowe A, Mackey P, Matull R, Thomas H, Vickery CJ, Caddy G, Foreman J, Hyland M, McCallion K, McFerran E, Tham T, Turkington J, Day S, Francombe J, Murphy P, Simmons E, Sinha R, Bull D, Compson A, Gould M, Ishaq S, Kawesha A, Maleki K, Marriott M, Poutney L, Stonelake PS, Adams C, Brundell S, Coleman M, Congdon H, Douie W, Eastlake L, Evenden L, Fox B, Gandy C, Georgiadis K, Hosie KB, Latchford A, Oppong FC, Pascoe J, Rance M, Shepherd E, Shirley J, Smith H, Appleton B, Bobary C, Feeney M, Gardner A, Krouma F, Richards D, Roche L, Tudor G, Young T, Olufunso A, Alderson D, Atif M, Bach S, Dasgin J, Forde C, Futaba K, Ghods-Ghorbani M, Gourevitch D, Ismail T, Keh C, Manimaran N, McCafferty I, Morton DG, Pandey S, Radley S, Riley P, Royle J, Suggett N, Torrance A, Tucker O, Vohra R, Aldous J, Beal D, Beveridge H, Bradshaw S, Carrick AJ, Coulson C, Dockree J, Fearon M, Hall A, Holding K, Hurst N, Irvine G, Langston K, Lund J, Redfern G, Reeves D, Reynolds JR, Rowntree J, Simmonds K, Singh R, Speake W, Tierney G, Tou S, Worth C, Singh B, Verma R, Allison J, Allison A, Bathurst N, Buckley C, Gotto J, Khan Z, Ockrim J, Rowland-Axe R, Russell A, Spurdle K, Williams-Yesson B, Ames A, Rylance PC, Dyer S, Fletcher J, Kent S, Law N, Macfie J, Mainprize K, Mallinson J, McNaught C, Mitchell C, Nunn A, Renwick IGH. Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial. Br J Surg 2022; 109:1073-1080. [PMID: 35986684 DOI: 10.1093/bjs/znac141] [Show More Authors] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. METHODS Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1-4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. RESULTS Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11-34) versus 18 (10-28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. CONCLUSION Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com).
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Lin T, Bissessur AS, Liao P, Yu T, Chen D. Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks. Front Surg 2022; 9:1006020. [PMID: 36211276 PMCID: PMC9535082 DOI: 10.3389/fsurg.2022.1006020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.
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Affiliation(s)
- Tianyu Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Saad Bissessur
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pengfei Liao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tunan Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dingwei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Dingwei Chen
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Oh HH, Cho SB, Hong JY, Kim DH, Yang HC, Kim SW, Lee J, Kim SJ, Han YD, Seo GS, Hong GY, Kim HD, Myung DS, Kim HS, Joo YE. Clinical outcomes of palliative self-expandable metal stent placement in right- and left-sided malignant colon obstruction: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study. Medicine (Baltimore) 2022; 101:e30156. [PMID: 36042619 PMCID: PMC9410579 DOI: 10.1097/md.0000000000030156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Self-expandable metal stent (SEMS) placement is commonly used for palliation of left-sided malignant colorectal obstruction (MCO). However, right-sided MCO is usually treated surgically. Recent studies that compared palliative SEMS insertion and emergency surgery in right-sided MCOs have reported conflicting results. This study aimed to compare the effectiveness of palliative SEMS placement in left-sided MCOs and right-sided MCOs and to investigate the predictive factors for clinical success and risk factors for complications. Data from 469 patients who underwent palliative SEMS placement for MCO at 6 hospitals in the Honam province of South Korea between 2009 and 2018 were reviewed. Among them, 69 patients with right-sided MCO and 400 patients with left-sided MCO who underwent SEMS placement for palliative purposes were enrolled. Clinical success, overall survival, complications, and predictive factors for clinical success and risk factors for complications were included as the main outcome measures. The clinical success rates were 97.1% (65/67) in right-sided MCO patients and 88.2% (353/400) in left-sided MCO patients. Complications including stent migration, tumor ingrowth, outgrowth, perforation, bacteremia/fever, and bleeding occurred in 10.1% (7/69) of right-sided MCO patients and 19.9% (79/400) of left-sided MCO patients. The mean overall survival of right-sided MCO was 28.02 months and 18.23 months for left-sided MCO. In multivariate logistic regression analysis, T3 stage tumors and the use of uncovered stents were significant factors for the clinical success of SEMS. The use of covered stents and performance status score of 0 to 2 were independent significant risk factors for complications. Palliative SEMS placement in right-sided MCO showed better clinical success rates than left-sided MCO. The use of uncovered stents is recommended for higher clinical success rates and lower complication rates.
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Affiliation(s)
- Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji-Yun Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Dong-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Chan Yang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Seong-Jung Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Yeom-Dong Han
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Geom-Seok Seo
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Gun-Young Hong
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Republic of Korea
| | - Ho-Dong Kim
- Department of Internal Medicine, Saint Carollo Hospital, Suncheon, Republic of Korea
| | - Dae-Seong Myung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Sharon CE, Song Y, Straker RJ, Kelly N, Shannon AB, Kelz RR, Mahmoud NN, Saur NM, Miura JT, Karakousis GC. Impact of the affordable care act's medicaid expansion on presentation stage and perioperative outcomes of colorectal cancer. J Surg Oncol 2022; 126:1471-1480. [PMID: 35984366 DOI: 10.1002/jso.27070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Medicaid expansion has improved healthcare coverage and preventive health service use. To what extent this has resulted in earlier stage colorectal cancer diagnoses and impacted perioperative outcomes is unclear. METHODS This was a retrospective difference-in-difference study using the National Cancer Database on adults (40-64) with Medicaid or no insurance, diagnosed with colorectal adenocarcinomas before (2010-2013) and after (2015-2018) expansion. The primary outcome was early-stage (American Joint Committee on Cancer Stage 0-1) diagnosis. The secondary outcomes were rate of local excision, emergency surgery, postoperative length of stay, rates of minimally invasive surgery, postoperative mortality, and overall survival (OS). RESULTS Medicaid expansion was associated with an increase in early-stage diagnoses for patients with colorectal cancers (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.15-1.43), an increase in local excision (OR: 1.39, 95% CI: 1.13-1.69), and a decreased rate of emergent surgery (OR: 0.85, 95% CI: 0.75-0.97) and 90-day mortality (OR: 0.75, 95% CI: 0.59-0.97). Additionally, patients in expansion states postexpansion had an improved 5-year OS (hazard ratio: 0.88, 95% CI: 0.83-0.94). CONCLUSIONS Insurance coverage expansion may be particularly important for optimizing stage of diagnosis, subsequent survival, and perioperative outcomes for socioeconomically vulnerable patients.
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Affiliation(s)
- Cimarron E Sharon
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yun Song
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Straker
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas Kelly
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adrienne B Shannon
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Najjia N Mahmoud
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole M Saur
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John T Miura
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Oh HH, Hong JY, Kim DH, Myung DS, Cho SB, Lee WS, Kim HS, Joo YE. Differences in clinical outcomes according to the time interval between the bridge to surgery stenting and surgery for left-sided malignant colorectal obstruction. World J Surg Oncol 2022; 20:178. [PMID: 35658875 PMCID: PMC9164395 DOI: 10.1186/s12957-022-02644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Self-expandable metal stent (SEMS) placement is commonly used as a bridge to surgery (BTS) for left-sided malignant colorectal obstruction (MCO). However, the optimal time interval between BTS stenting and surgery for left-sided MCO is unclear, and the results of previous studies are conflicting. This study aimed to determine the differences in clinical outcomes according to the time interval between BTS stenting and surgery in left-sided MCO. METHODS Data from 594 patients who underwent SEMS placement for MCO between January 2009 and December 2018 were reviewed. Among them, 148 patients who underwent SEMS placement as BTS treatment and curative surgery were enrolled. The enrolled patients were divided into three groups according to the interval between BTS stenting and surgery: group 1 (interval ≤2 weeks), group 2 (interval 2-3 weeks), and group 3 (interval >3 weeks). RESULTS Group 2 and 3 patients underwent significantly higher rates of laparoscopic surgery than those in group 1 (83.7, 81.0 vs. 53.2 %, respectively; P=0.003, P=0.003, respectively). Also, rates of stoma formation directly after resection were significantly higher in group 1 compared to groups 2 and 3 (21.3 vs 2.3, 6.9%, respectively; P=0.008, P=0.043, respectively). Bridging interval had no effect on SEMS-related complications, resection-related complications, 90-day mortality, permanent stoma formation, 3-year disease-free survival, and 3-year overall survival. CONCLUSIONS A bridging interval of > 2 weeks between BTS stenting and surgery for left-sided MCO is preferable for lower stoma formation rates and higher rates of laparoscopic approach operation, with no difference in short-term and long-term outcomes including complication, mortality, and survival.
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Affiliation(s)
- Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Ji-Yun Hong
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Dong-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Dae-Seong Myung
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-Dong, Dong-ku, Gwangju, 501-757, Republic of Korea.
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Kim SH, Jang SH, Jeon HJ, Choi HS, Kim ES, Keum B, Jeen YT, Chun HJ, Kim J. Colonic stenting as a bridge to surgery for obstructive colon cancer: is it safe in the long term? Surg Endosc 2022; 36:4392-4400. [PMID: 35075522 DOI: 10.1007/s00464-021-08789-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The placement of a self-expanding metal stent in patients with obstructive colon cancer is used as a bridge to surgery. However, due to a lack of consensus and insufficient data, the long-term oncologic outcomes after colonic SEMS placement remain unclear. We assessed the long-term oncologic outcomes and adverse effects of colonic stenting for malignant colonic obstruction. METHODS We included 198 patients admitted to Korea University Anam Hospital between 2006 and 2014 for obstructive colon cancer, of whom 98 underwent SEMS placement as a bridge to surgery and 100 underwent direct surgery without stenting. The clinicopathologic characteristics, overall survival, and disease-free survival were compared. RESULTS There were no significant differences in long-term oncologic outcomes between the two groups. The median follow-up durations were 61.55 and 58.64 months in the SEMS and DS groups, respectively. There were also no significant differences in the 5-year OS (77.4% vs. 74.2%, p = 0.691) and 5-year DFS (61.7% vs. 71.0%, p = 0.194) rates between the groups. However, the DS group had significantly more early postoperative complications (p = 0.002). CONCLUSIONS Colonic SEMS deployment as a bridge to surgery did not negatively affect long-term oncologic outcomes when compared with DS. In addition, colonic stenting decreased early postoperative complications and reduced the time for patients to return to normal daily activities.
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Affiliation(s)
- Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Se Hyun Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jin Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University College of Medicine, Robotic & MIS Center, Korea University Medical Center, Seoul, Republic of Korea.
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New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
(1) Background: The COVID-19 pandemic put a great burden on national healthcare systems, causing delays and disruptions in the medical care of non-COVID-19 patients. This paper aims to analyze the COVID-19 pandemic impact upon the quality of care in colorectal surgery. (2) Materials and Methods: We performed a retrospective study on the colorectal cancer cases operated in the Fourth Department of General Surgery, Emergency Hospital Bucharest Romania, over the period March 2020–February 2021 (pandemic group) vs. March 2019–February 2020 (non-pandemic group). (3) Results: The number of patients in the pandemic group decreased by 70% (36 vs. 118 patients), with lower accessibility from rural areas (11.1% vs. 37.2%, p = 0.035). Most cases in the pandemic group were emergencies (69% vs. 37.3%, p = 0.009), admitted for bowel obstruction (63.8% vs. 27.9%, p = 0.008). There was no in-hospital COVID-19 infection in patients operated for colorectal cancer. The 30-day mortality was significantly higher in the pandemic group (25% vs. 6.7%, p = 0.017), mostly due to septic shock (36.1% vs. 5%, p = 0.0001). (4) Conclusions: Colorectal cancer surgery may be performed safely during the COVID-19 pandemic, with strict adherence to the SARS-CoV-2 prevention protocols. However, the significant increase in colorectal cancers in the emergency was associated with worse outcomes and higher mortality during the COVID-19 pandemic.
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Yokoyama Y, Emoto S, Nozawa H, Kawai K, Sasaki K, Murono K, Ishibashi R, Koike K, Ishihara S. Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes. Scand J Surg 2022; 111:14574969221096191. [PMID: 35549944 DOI: 10.1177/14574969221096191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Laparoscopic resection for obstructive colon cancer (CC) after insertion of self-expanding metallic stents (SEMSs) is reportedly difficult. However, this has not yet been thoroughly investigated. Therefore, we investigated the influence of SEMS insertion on laparoscopic resection. METHODS This retrospective comparative study included 87 patients with obstructive left-sided CC (December 2011-December 2019). Patients were assigned to two groups based on elective laparoscopic surgery for (1) obstructive CC necessitating emergent decompression with SEMS insertion (SEMS group) and (2) obstructive CC without emergent decompression (control group). RESULTS The SEMS group had a longer operation time (283.3 ± 79.3 min vs 222.2 ± 79.4 min, P = 0.002) and greater blood loss (204.8 ± 417.6 mL vs 53.7 ± 166.1 mL, P = 0.029) on univariate analysis; however, in multiple linear regression analysis, SEMS was not an independent risk factor for both operation time (Δ operation time 25.5 min: P = 0.19) and blood loss (Δ blood loss 33.6 mL: P = 0.58). The complication rate based on Clavien-Dindo grade II did not differ significantly (17% vs 20%, P = 1.00), whereas the rates of conversion to laparotomy (17% vs 2%, P = 0.016) and stoma creation (26% vs 2%, P = 0.001) were higher in the SEMS group. In oncological outcomes, there was no intergroup difference in the 5-year disease-free survival (80.0% vs 72.2%, P = 0.76) and overall survival (100% vs 86.3%, P = 0.25). CONCLUSIONS Laparoscopic surgery after SEMS for left-sided CC is demanding due to higher conversion rates to open surgery. However, this study also revealed that it is as safe as laparoscopic surgery for cases without SEMS because of comparable complication rate and long-term outcomes.
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Affiliation(s)
- Yuichiro Yokoyama
- Department of Surgical Oncology University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655 Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Rei Ishibashi
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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A Brave New World: Colorectal Anastomosis in Trauma, Diverticulitis, Peritonitis, and Colonic Obstruction. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Self-Expanding Metal Stents Do Not Adversely Affect Long-term Outcomes in Acute Malignant Large-Bowel Obstruction: A Retrospective Analysis. Dis Colon Rectum 2022; 65:228-237. [PMID: 34990424 DOI: 10.1097/dcr.0000000000002084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Self-expanding metal stents as a bridge to surgery in acute malignant large-bowel obstruction has gained popularity. However, long-term oncologic outcomes have not been well established. OBJECTIVE To investigate long-term oncologic outcomes of patients undergoing curative resection after the placement of a colonic stent compared with emergency surgery for acute malignant large-bowel obstruction. DESIGN This is a retrospective study. SETTING All patients presenting at 3 tertiary care centers between April 2002 and December 2012 with a diagnosis of complete malignant large-bowel obstruction were reviewed. Patients with disease distal to the hepatic flexure were selected for analysis. PATIENTS One hundred twenty-two patients who underwent either emergency surgery or placement of a colonic stent with curative intent were included. INTERVENTIONS Patients receiving emergency surgery within 24 hours of presenting with obstructive symptoms, including those with failed stents, were included in the emergency surgery group. All patients with clinically successful stent deployment before surgery were included in the stent group. MAIN OUTCOME MEASURES Overall survival and disease-free survival were calculated using the Kaplan-Meier method. RESULTS Sixty-four patients underwent emergency surgery, and 58 patients underwent placement of a self-expanding metal stent. Groups were similar in terms of sex, tumor stage and grade, and Charlson and Charlson-Age Comorbidity Index scores. Patients in the surgery group were older than patients in the stent group. There were no differences in the number of lymph nodes harvested, positive nodes, rates of vascular and perineural invasion, or utilization of chemotherapy. Thirty-day mortality after resection was similar between groups (7.41% vs 4.41%; p > 0.05). Patients who underwent colonic stenting as a bridge to surgery had similar 10-year overall survival (40.5% vs 32.7%; p = 0.13) and 10-year disease-free survival (40.2% vs 33.8%; p = 0.26) compared with those who underwent emergency surgery. Similar results were seen on intention-to-treat analysis. LIMITATIONS This was a small retrospective study. CONCLUSIONS Stent insertion followed by oncologic resection is associated with similar overall survival and disease-free survival compared with emergency resection. Stent insertion as a bridge to surgery should be considered in patients presenting with malignant colorectal obstruction. See Video Abstract at http://links.lww.com/DCR/B714Los Stents Metálicos Autoexpandibles No Afectan Negativamente Los Resultados A Largo Plazo En La Obstrucción Maligna Aguda Del Colon: Un Análisis Retrospectivo. ANTECEDENTES Los stents metálicos autoexpandibles como puente a una cirugía en la obstrucción maligna aguda del colon han ganado popularidad. Sin embargo, no se han establecido bien los resultados oncológicos a largo plazo. OBJETIVO Investigar los resultados oncológicos a largo plazo de los pacientes sometidos a resección curativa después de la colocación de un stent colónico en comparación con la cirugía de urgencia para la obstrucción maligna aguda del colon. DISEO Estudio retrospectivo. MBITO Entre abril de 2002 y diciembre de 2012, se revisaron todos los pacientes que acudieron a tres centros de tercer nivel con un diagnóstico de obstrucción maligna completa del colon. Se seleccionaron para el análisis los pacientes con enfermedad distal al ángulo hepático. PACIENTES Se incluyeron 122 pacientes que fueron operados de urgencia o a una colocación de un stent colónico con intención curativa. PROCEDIMIENTOS Los pacientes que se sometieron a cirugía de urgencia dentro de las 24 horas posteriores a la presentación de síntomas obstructivos; se incluyeron aquellos con stents fallidos en el grupo de cirugía de urgencia. Todos los pacientes con colocación clínicamente exitosa del stent antes de la cirugía se incluyeron en el grupo de stent. PRINCIPALES VARIABLES ANALIZADAS La sobrevida global y la sobrevida libre de enfermedad se calcularon mediante el método de Kaplan-Meier. RESULTADOS Sesenta y cuatro pacientes fueron llevados a cirugía urgente y en 58 pacientes se colocó de un stent metálico autoexpandible. Los grupos fueron similares en relación a sexo, estadio y grado del tumor, puntuación de comorbilidad de Charlson y Charlson-Age. Los pacientes del grupo de cirugía eran mayores que los del grupo de stents. No hubo diferencias en el número de ganglios linfáticos recolectados, ganglios positivos, tasas de invasión vascular y perineural o utilización de quimioterapia. La mortalidad a los 30 días después de la resección fue similar entre los grupos (7,41% frente a 4,41%; p> 0,05). Los pacientes que se sometieron a la colocación de un stent colónico como puente a la cirugía tuvieron una sobrevida general a diez años similar (40,5% vs 32,7%; p = 0,13) y una sobrevida libre de enfermedad a diez años (40,2% vs 33,8%, respectivamente; p = 0,26) en comparación a los operados de urgencia. Se observaron resultados similares en el análisis por intención de tratamiento. LIMITACIONES Estudio retrospectivo reducido. CONCLUSIONES La utilización de un stent y posteriormente la resección oncológica se asocia a una sobrevida general y una sobrevida libre de enfermedad similar en comparación con la resección de urgencia. La utilización de un stent como puente a la cirugía debe considerarse en pacientes que presentan obstrucción colorrectal maligna. Consulte Video Resumen en http://links.lww.com/DCR/B714. (Traducción-Dr. Lisbeth Alarcon-Bernes).
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Hu HT, Park JH, Wang Z, Bakheet N, Xu SJ, Lee EJ, Kim DH, Kim SH, Song HY, Jeon JY, Chang S. Localized Photothermal Ablation Therapy of Obstructive Rectal Cancer Using a Nanofunctionalized Stent in a Mouse Model. ACS Biomater Sci Eng 2021; 7:5890-5898. [PMID: 34817170 DOI: 10.1021/acsbiomaterials.1c01166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The self-expanding metal stent (SEMS) is a versatile, palliative treatment method for unresectable, malignant, non-vascular strictures. Colorectal cancer (CRC) is one of the candidates for the application of the SEMS, in combination with the photothermal ablation (PTA) technique that enhances its therapeutic efficacy. The objective of this study was to investigate the efficacy of stent-mediated PTA therapy in an endoscopy-guided, orthotopic rectal cancer model. A total of 30 of 40 mice with the tumor size of grade 4 were included and were divided into three groups of 10 mice each. Group A underwent a gold nanoparticle (AuNP)-coated SEMS but no near-infrared (NIR) irradiation, group B received an uncoated control SEMS with NIR irradiation, and group C received a AuNP-coated SEMS and NIR irradiation together. Colonoscopy and in vivo imaging, immunohistochemical analysis, and quantitative reverse-transcription polymerase chain reaction of major tumor markers were performed. Stent placement and PTA were technically successful using colonoscopy. The tumor grade reduction after PTA is significant in group C, compared with groups A or B (p < 0.001). Molecular analysis validated this observation with a significantly reduced Mapk1 proliferation marker or increased Jnk expression. Histological analysis confirmed the localized PTA therapy using AuNP-coated SEMS profoundly ablated tumor outgrowth through the stent. Our results indicate that this novel strategy of localized PTA therapy could be a promising option for palliative treatment of CRC and to support prolonged stent patency with a decreased tumor volume.
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Affiliation(s)
- Hong-Tao Hu
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.,Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou 450003, Henan Province, China
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Zhe Wang
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin 300052, China
| | - Nader Bakheet
- Gastrointestinal Endoscopy and Liver Unit, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11559, Egypt
| | - Shi-Jun Xu
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.,Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou 450003, Henan Province, China
| | - Eun Ji Lee
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, United States
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ho-Young Song
- Department of Radiology, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, United States
| | - Jae Yong Jeon
- Department of Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Suhwan Chang
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Shinkwin M, Silva L, Vogel I, Reeves N, Cornish J, Horwood J, Davies MM, Torkington J, Ansell J. COVID-19 and the emergency presentation of colorectal cancer. Colorectal Dis 2021; 23:2014-2019. [PMID: 33793063 PMCID: PMC8250723 DOI: 10.1111/codi.15662] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022]
Abstract
AIM The COVID-19 pandemic led to widespread disruption of colorectal cancer services during 2020. Established cancer referral pathways were modified in response to reduced diagnostic availability. The aim of this paper is to assess the impact of COVID-19 on colorectal cancer referral, presentation and stage. METHODS This was a single centre, retrospective cohort study performed at a tertiary referral centre. Patients diagnosed and managed with colorectal adenocarcinoma between January and December 2020 were compared with patients from 2018 and 2019 in terms of demographics, mode of presentation and pathological cancer staging. RESULTS In all, 272 patients were diagnosed with colorectal adenocarcinoma during 2020 compared with 282 in 2019 and 257 in 2018. Patients in all years were comparable for age, gender and tumour location (P > 0.05). There was a significant decrease in urgent suspected cancer referrals, diagnostic colonoscopy and radiological imaging performed between March and June 2020 compared with previous years. More patients presented as emergencies (P = 0.03) with increased rates of large bowel obstruction in 2020 compared with 2018-2019 (P = 0.01). The distribution of TNM grade was similar across the 3 years but more T4 cancers were diagnosed in 2020 versus 2018-2019 (P = 0.03). CONCLUSION This study demonstrates that a relatively short-term impact on the colorectal cancer referral pathway can have significant consequences on patient presentation leading to higher risk emergency presentation and surgery at a more advanced stage. It is therefore critical that efforts are made to make this pathway more robust to minimize the impact of other future adverse events and to consolidate the benefits of earlier diagnosis and treatment.
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Affiliation(s)
- Michael Shinkwin
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Louise Silva
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Irene Vogel
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Nicola Reeves
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Julie Cornish
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - James Horwood
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Michael M Davies
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - Jared Torkington
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
| | - James Ansell
- Department of Colorectal SurgeryUniversity Hospital of WalesCardiffUK
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Uehara H, Yamazaki T, Iwaya A, Kameyama H, Komatsu M, Hirai M. Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II to III Obstructive Colorectal Cancer: A Retrospective Study. Ann Coloproctol 2021; 38:235-243. [PMID: 34256426 PMCID: PMC9263314 DOI: 10.3393/ac.2020.01067.0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/27/2021] [Indexed: 10/25/2022] Open
Abstract
Purpose We evaluated the oncological outcomes of bridge to surgery (BTS) using stent compared with surgery alone for obstructive colorectal cancer. Methods Consecutive patients who underwent curative resection for stages II to III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the 2 groups. Results Stent-related perforation did not occur. One patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression (clinical success rate, 97.7%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group; nonemergency surgery (P<0.001), surgical approach (P=0.006), and length of hospital stay (P=0.020). The median follow-up time was 44.9 months (range, 1.1-126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P=0.411), and the overall survival rates were 78.3% and 88.2% (P=0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P=0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P=0.035) in the surgery alone and BTS groups, respectively. Conclusion This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II to III obstructive colorectal cancer potentially worsens oncological outcomes.
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Affiliation(s)
- Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Masaru Komatsu
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Motoharu Hirai
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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Holtedahl K, Borgquist L, Donker GA, Buntinx F, Weller D, Campbell C, Månsson J, Hammersley V, Braaten T, Parajuli R. Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care. BMC FAMILY PRACTICE 2021; 22:148. [PMID: 34238248 PMCID: PMC8268573 DOI: 10.1186/s12875-021-01452-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. METHOD Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher's exact test was used to analyse differences between groups. RESULTS Almost all symptoms recorded could indicate colorectal cancer. 'Rectal bleeding' had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had 'Rectal bleeding' at the initial consultation, but three of the 18 did so at a later consultation. 'Abdominal pain, lower part', 'Constipation' and 'Distended abdomen, bloating' were less specific and also less sensitive than 'Rectal bleeding', and with PPV between 0.7% and 1.9%. CONCLUSIONS Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.
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Affiliation(s)
- Knut Holtedahl
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Lars Borgquist
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Gé A. Donker
- Netherlands Institute of Health Services Research, Otterstraat 118, Utrecht, 3513 the Netherlands
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
- Maastricht University, P.O. Box 616, Maastricht, 6200 The Netherlands
| | - David Weller
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Box 100, 40530 Gothenburgh, Sweden
| | - Victoria Hammersley
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Tonje Braaten
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Ranjan Parajuli
- Faculty of Nursing and Health Sciences, Nord University, P.O.Box 1490, 8049 Bodø, Norway
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Matsuda A, Yamada T, Takahashi G, Toyoda T, Matsumoto S, Shinji S, Ohta R, Sonoda H, Yokoyama Y, Sekiguchi K, Yoshida H. Does the diameter of colonic stent influence the outcomes in bridge-to-surgery patients with malignant large bowel obstruction? Surg Today 2021; 51:986-993. [PMID: 33247782 DOI: 10.1007/s00595-020-02185-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This study investigated the short- and long-term outcomes of 18- and 22-mm-diameter self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) in patients with malignant large bowel obstruction (MLBO). METHODS Sixty-nine pathological stage II and III colorectal cancer patients who underwent BTS were included in this multi-institutional retrospective study. Patients were divided into two groups regarding the diameter of SEMS: an 18-mm group (n = 30) and a 22-mm group (n = 39). RESULTS There was no significant difference in the clinical success rate, but both of the two re-obstructions observed occurred in the 18-mm group. The 18-mm group showed a trend toward a higher incidence of overall postoperative complications (Clavien-Dindo grading ≥ II) than the 22-mm group (33.3% vs. 10.3%, P = 0.061). The 3-year disease-free and overall survival showed no significant differences between the 18- and 22-mm groups (78.2% vs. 68.8%, P = 0.753 and 92.8% vs. 82.1%, P = 0.471, respectively). CONCLUSION SEMS of 18 and 22 mm diameter confer statistically equivalent short- and long-term outcomes as a BTS.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Goro Takahashi
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tetsutaka Toyoda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryo Ohta
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kumiko Sekiguchi
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Mahfouz MF, Salama TMS, Afifi AH, Dabous HMK. Effectiveness and Early Postoperative Outcomes of Palliative Endoluminal Stenting Versus Hartmann's Procedure in Acute Malignant Bowel Obstruction in High-risk Patients. Ann Coloproctol 2021; 38:141-145. [PMID: 34167187 PMCID: PMC9021855 DOI: 10.3393/ac.2021.01.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery. Methods An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann’s procedure, HP), and 35 patients underwent SEMS insertion. Results All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. Conclusion SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.
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Affiliation(s)
| | - Tamer M Saeid Salama
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr H Afifi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Trabulsi NH, Halawani HM, Alshahrani EA, Alamoudi RM, Jambi SK, Akeel NY, Farsi AH, Nassif MO, Samkari AA, Saleem AM, Malibary NH, Abbas MM, Gianotti L, Lamazza A, Yoon JY, Farsi NJ. Short-term outcomes of stents in obstructive rectal cancer: A systematic review and meta-analysis. Saudi J Gastroenterol 2021; 27:127-135. [PMID: 33976008 PMCID: PMC8265400 DOI: 10.4103/sjg.sjg_506_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients. METHODS We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates. RESULTS We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I2 = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I2 = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I2 = 79.3%, P < 0.001). CONCLUSION The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.
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Affiliation(s)
- Nora H. Trabulsi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hajar M. Halawani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Rawan M. Alamoudi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sama K. Jambi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nouf Y. Akeel
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali H. Farsi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed O. Nassif
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali A. Samkari
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulaziz M. Saleem
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nadim H. Malibary
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad M. Abbas
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Luca Gianotti
- Department of Surgery, School of Medicine and Surgery, University of Milano-Bicocca, and San Gerardo Hospital, Monza, Italy
| | - Antonietta Lamazza
- Department Pietro Valdoni-Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Jin Young Yoon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Nada J. Farsi
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Yagawa Y, Kudo SE, Miyachi H, Mori Y, Misawa M, Sato Y, Kudo K, Ishigaki T, Ichimasa K, Kudo T, Hayashi T, Wakamura K, Baba T, Ishida F. Short- and long-term outcomes of self-expanding metallic stent placement vs. emergency surgery for malignant colorectal obstruction. Mol Clin Oncol 2021; 14:63. [PMID: 33680454 PMCID: PMC7890458 DOI: 10.3892/mco.2021.2225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023] Open
Abstract
The European Society of Gastrointestinal Endoscopy does not recommend self-expanding metal stent (SEMS) placement as a bridge to surgery (BTS) for malignant colorectal obstruction (MCRO). However, no universally accepted consensus has been determined. The present study aimed to evaluate the short- and long-term outcomes of SEMS placement vs. emergency surgery (ES) for MCRO. Surgical resection of colorectal cancer was performed in 3,840 patients between April 2001 and June 2016. Of these, 93 patients had MCRO requiring emergency decompression. Only patients in whom the colorectal lesion was ultimately resected were included; thus, the present study included 62 patients treated with MCRO via SEMS placement as a BTS (n=25) or via ES (n=37). The rates of laparoscopic surgery, primary anastomosis, stoma formation, lymph node dissection, adverse events, 30-day mortality and disease-free survival were evaluated. The clinical success rate of SEMS placement was 92.0% (23/25). Compared with the ES group, the SEMS group had higher rates of laparoscopic surgery (68.0 vs. 2.7%; P<0.001) and primary anastomosis (88.0 vs. 51.4%; P=0.003), a greater number of dissected lymph nodes (30 vs. 18; P=0.001), and lower incidences of stoma formation (24.0 vs. 67.6%; P=0.002) and overall adverse events (24.0 vs. 62.2%; P=0.004). The 30-day mortality and disease-free survival of the SEMS group were not significantly different to that of the ES group (0 vs. 2.7%; P=1.000; log-rank test; P=0.10). In conclusion, as long as adverse events such as perforation are minimized, SEMS placement as a BTS could be a first treatment option for MCRO. The present study is registered in the University Hospital Medical Network Clinical Trials Registry (UMIN R000034868).
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Affiliation(s)
- Yusuke Yagawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Yuta Sato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Koki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Tomoyuki Ishigaki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Toshiyuki Baba
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa 224-8503, Japan
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Veld JV, Beek KJ, Consten EC, ter Borg F, van Westreenen HL, Bemelman WA, van Hooft JE, Tanis PJ. Definition of large bowel obstruction by primary colorectal cancer: A systematic review. Colorectal Dis 2021; 23:787-804. [PMID: 33305454 PMCID: PMC8248390 DOI: 10.1111/codi.15479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
AIM Controversies on therapeutic strategy for large bowel obstruction by primary colorectal cancer mainly concern acute conditions, being essentially different from subacute obstruction. Clearly defining acute obstruction is important for design and interpretation of studies as well as for guidelines and daily practice. This systematic review aimed to evaluate definitions of obstruction by colorectal cancer in prospective studies. METHOD A systematic search was performed in PubMed, Embase and the Cochrane Library. Eligibility criteria included randomized or prospective observational design, publication between 2000 and 2019, and the inclusion of patients with an obstruction caused by colorectal cancer. Provided definitions of obstruction were extracted with assessment of common elements. RESULTS A total of 16 randomized controlled trials (RCTs) and 99 prospective observational studies were included. Obstruction was specified as acute in 28 studies, complete/emergency in five, (sub)acute or similar terms in four and unspecified in 78. Five of 16 RCTs (31%) and 37 of 99 cohort studies (37%) provided a definition. The definitions included any combination of clinical symptoms, physical signs, endoscopic features and radiological imaging findings in 25 studies. The definition was only based on clinical symptoms in 11 and radiological imaging in six studies. Definitions included a radiological component in 100% of evaluable RCTs (5/5) vs. 54% of prospective observational studies (20/37, P = 0.07). CONCLUSION In this systematic review, the majority of prospective studies did not define obstruction by colorectal cancer and its urgency, whereas provided definitions varied hugely. Radiological confirmation seems to be an essential component in defining acute obstruction.
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Affiliation(s)
- Joyce V. Veld
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kim J. Beek
- Department of Gastroenterology and HepatologyNWZ AlkmaarAlkmaarThe Netherlands
| | - Esther C.J. Consten
- Department of SurgeryMeander Medical CenterAmersfoortThe Netherlands,Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and HepatologyDeventer HospitalDeventerThe Netherlands
| | | | - Wilhelmus A. Bemelman
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Pieter J. Tanis
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Sugiura K, Seo Y, Aoki H, Onishi Y, Nishi Y, Kishida N, Tanaka M, Ito Y, Tokura H, Takahashi T. Bridge to Surgery for Obstructing Colonic Cancer: A Comparison between Right- and Left-sided Lesions. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:34-39. [PMID: 33537498 PMCID: PMC7843137 DOI: 10.23922/jarc.2020-046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 01/11/2023]
Abstract
Objectives: Few studies have compared management and outcomes of bridge to surgery (BTS) for obstructive colonic cancer according to the location of the tumor. Additional information is needed about this procedure's characteristics and short-term and long-term outcomes. We aimed to compare patient and tumor characteristics, and outcomes of BTS for obstructive right-sided versus left-sided colonic cancers. Methods: This was a retrospective, single center, cohort study. The study cohort comprised 149 patients, including 48 with right-sided and 101 with left-sided obstructive colonic cancers, who were treated with BTS between January 2007 and December 2017. Data on medical history, investigations, treatments, and prognosis were collected from an electronic database of a single hospital. The primary end points were overall (OS) and disease-free (DFS) survival and short-term surgical outcomes. Results: Significantly more patients with right-sided cancers had postoperative complications (29.2% vs. 14.9%, p = 0.039). Additionally, postoperative chemotherapy was administered to a marginally significantly greater proportion of patients with left-sided cancers (29.2% vs 45.5%, p = 0.057). The long-term outcomes were comparable between the two groups (the 5-year OS rates were 67.6% and 80.9% [p = 0.117] and the 5-year DFS rates were 62.2% and 58.6% [p = 0.671]). Multivariate analyses using all studied variables showed that lymphovascular invasion, advanced T stage, and adjuvant chemotherapy were independent poor prognostic factors. Conclusions: The long-term outcome was not different between the right- and left-sided groups. In a BTS setting, postoperative complications may reduce the compliance of adjuvant chemotherapy in right-sided cancers and affect long-term outcomes.
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Affiliation(s)
- Kiyoaki Sugiura
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Yuki Seo
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Hikaru Aoki
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Yoshihiko Onishi
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Yusuke Nishi
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Norihiro Kishida
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Motomu Tanaka
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Yasuhiro Ito
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Hideyuki Tokura
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
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Li B, Cai SL, Lv ZT, Zhou PH, Yao LQ, Shi Q, Qi ZP, Sun D, Yalikong A, Xu EP, Xu JM, Zhong YS. Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction. BMC Surg 2020; 20:326. [PMID: 33302923 PMCID: PMC7727111 DOI: 10.1186/s12893-020-00993-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. METHODS Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. RESULTS In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858-12.370; P = 0.041). CONCLUSION Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.
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Affiliation(s)
- Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Zhen-Tao Lv
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Li-Qing Yao
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Ayimukedisi Yalikong
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - En-Pan Xu
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Jian-Min Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
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A prospective, single-arm, multicenter trial of diverting stoma followed by neoadjuvant chemotherapy using mFOLFOX6 for obstructive colon cancer. Ann Surg 2020; 276:140-145. [DOI: 10.1097/sla.0000000000004494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Moghadamyeghaneh Z, Talus H, Ballantyne G, Stamos MJ, Pigazzi A. Short-term outcomes of laparoscopic approach to colonic obstruction for colon cancer. Surg Endosc 2020; 35:2986-2996. [PMID: 32572627 DOI: 10.1007/s00464-020-07743-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 06/12/2020] [Indexed: 03/29/2025]
Abstract
BACKGROUND We speculated that a laparoscopic approach to emergent/urgent partial colectomy for colonic obstruction would be associated with less morbidity and shorter length of stay with similar mortality to open colectomy. We compared the outcomes of laparoscopic and open approaches to emergent/urgent partial colectomy for colonic obstruction from colonic cancer using data from the National Surgical Quality Improvement Program (NSQIP) database for the period of 2012-2017. METHODS Multivariate analysis compared NSQIP data points following laparoscopic, laparoscopic converted to open, and open colectomy for emergent/urgent colectomy for colonic obstruction from colon cancer from 2012 to 2017. RESULTS A total of 1293 patients who underwent emergent colectomy for colon obstruction from colon cancer during 2012-2017 were identified within the NSQIP database. Laparoscopic approach was used for colonic obstruction in 19.3% of operations with a conversion rate of 28.5%. A laparoscopic approach to obstructing colonic cancers was associated with lower morbidity (50% vs. 61.8%, AOR: 0.67, P = 0.01) and shorter hospitalization length (10 days vs. 13 days, mean difference: 3 days, P < 0.01) compared with an open approach. However, the mean operation duration was longer in laparoscopic operations than open operations (159 min vs. 137 min, P < 0.01). CONCLUSION A laparoscopic approach to malignant colonic obstruction is associated with decreased morbidity. This suggests that efforts should be directed towards increasing the utilization of laparoscopic approaches for the surgical treatment of colonic obstruction.
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Affiliation(s)
| | - Henry Talus
- Department of Surgery, State University of New York, Downstate, New York, USA
| | - Garth Ballantyne
- Department of Surgery, State University of New York, Downstate, New York, USA
| | | | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, USA. .,Division of Surgical Oncology, Department of Surgery, University of California Irvine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA.
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49
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Tebala GD, Mingoli A, Natili A, Khan AQ, Brachini G. Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study. Ann Coloproctol 2020; 37:21-28. [PMID: 32178504 PMCID: PMC7989555 DOI: 10.3393/ac.2019.03.10.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/10/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The treatment of acutely obstructing colorectal cancers is still a matter of debate. The prevailing opinion is that an immediate resection should be performed whenever possible. This study sought to determine whether immediate resection is safe and oncologically valid. Methods We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble’s Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest. Results Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. Conclusion Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.
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Affiliation(s)
- Giovanni Domenico Tebala
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Mingoli
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
| | - Andrea Natili
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy.,General and Transplantation Surgery Unit, S. Salvatore Regional Hospital, L'Aquila, Italy
| | | | - Gioia Brachini
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
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50
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Fahim M, Dijksman L, van Kessel C, Smeeing D, Braaksma A, Derksen W, Smits A. Promising results of a new treatment in patients with bowel obstruction in colorectal surgery. Eur J Surg Oncol 2020; 46:415-419. [DOI: 10.1016/j.ejso.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022] Open
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