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Yu N, Lin S, Wang X, Hu G, Xie R, Que Z, Lai R, Xu D. Endoscopic obstruction predominantly occurs in right-side colon cancer and endoscopic obstruction with tumor size ≤ 5 cm seems poor prognosis in colorectal cancer. Front Oncol 2024; 14:1415345. [PMID: 38947895 PMCID: PMC11211365 DOI: 10.3389/fonc.2024.1415345] [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] [Received: 04/10/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Background Endoscopic obstruction (eOB) is associated with a poor prognosis in colorectal cancer (CRC). Our study aimed to investigate the association between tumor location and eOB, as well as the prognostic differences among non-endoscopic obstruction (N-eOB), eOB with tumor size ≤ 5 cm, and eOB with tumor size > 5 cm in non-elderly patients. Methods We retrospectively reviewed the clinicopathological variables of 230 patients with CRC who underwent curative surgery. The multivariable logistic regression model was used to identify risk factors for eOB. The association between eOB with tumor size ≤ 5 cm and disease-free survival (DFS) was evaluated using multivariate cox regression analysis. Results A total of 87 patients had eOB while 143 had N-eOB. In multivariate analysis, preoperative carcinoembryonic antigen (p = 0.014), tumor size (p = 0.010), tumor location (left-side colon; p = 0.033; rectum; p < 0.001), and pT stage (T3, p = 0.009; T4, p < 0.001) were significant factors of eOB. The DFS rate for eOB with tumor size ≤ 5 cm was significantly lower (p < 0.001) in survival analysis. The eOB with tumor size ≤ 5 cm (p = 0.012) was an unfavorable independent factor for DFS. Conclusions The patients with eOB were significantly associated with right-side colon cancer as opposed to left-side colon cancer and rectal cancer. The eOB with tumor size ≤ 5 cm was an independent poor prognostic factor. Further studies are needed to target these high-risk groups.
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Affiliation(s)
- Nong Yu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Shuangming Lin
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Guoxin Hu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Run Xie
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Zhipeng Que
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Runsheng Lai
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Dongbo Xu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
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Sullivan J, Donohue A, Brown S. Colorectal Oncologic Emergencies: Recognition, Management, and Outcomes. Surg Clin North Am 2024; 104:631-646. [PMID: 38677826 DOI: 10.1016/j.suc.2023.12.003] [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: 04/29/2024]
Abstract
Colorectal cancer is the third most frequent type of malignancy in the United States, and the age at diagnosis is decreasing. Although the goal of screening is focused on prevention and early detection, a subset of patients inevitably presents as oncologic emergencies. Approximately 15% of patients with colorectal cancer will present as surgical emergencies, with the majority being due to either colonic perforation or obstruction. Patients presenting with colorectal emergencies are a challenging cohort, as they often present at an advanced stage with an increase in T stage, lymphovascular invasion, and metachronous liver disease.
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Affiliation(s)
- Joshua Sullivan
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA
| | - Alec Donohue
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA
| | - Shaun Brown
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA.
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Coman IS, Vital RC, Coman VE, Burleanu C, Liţescu M, Florea CG, Cristian DA, Gorecki GP, Radu PA, Pleşea IE, Erchid A, Grigorean VT. Emergency and Elective Colorectal Cancer-Relationship between Clinical Factors, Tumor Topography and Surgical Strategies: A Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:898. [PMID: 38929515 PMCID: PMC11205460 DOI: 10.3390/medicina60060898] [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: 05/02/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The purpose of the study was to analyze the relationships among several clinical factors and also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020-2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A total of 69 patients had emergency surgery (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients, and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, and an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of patients and their families, and also the financial costs of the medical systems.
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Affiliation(s)
- Ionuţ Simion Coman
- 10th Clinical Department—General Surgery, Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Raluca Cristina Vital
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Violeta Elena Coman
- 10th Clinical Department—General Surgery, Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Cosmin Burleanu
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Mircea Liţescu
- 2nd Department of Surgery and General Anesthesia, Discipline of Surgery and General Anesthesia—“Sf. Ioan” Clinical Emergency Hospital, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Costin George Florea
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Daniel Alin Cristian
- 10th Clinical Department—General Surgery, Discipline of General Surgery—“Colţea” Clinical Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
- General Surgery Department, “Colţea” Clinical Hospital, 1 Ion C. Brătianu Boulevard, 030167 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Faculty of Medicine, “Titu Maiorescu” University, 67A Gheorghe Petraşcu Street, 031593 Bucharest, Romania;
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 63 Mărăşti Boulevard, 011464 Bucharest, Romania
| | - Petru Adrian Radu
- 10th Clinical Department—General Surgery, Discipline of General Surgery—“Dr. Carol Davila” Clinical Nephrology Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
- General Surgery Department, “Dr. Carol Davila” Clinical Nephrology Hospital, 4 Griviţei Road, 010731 Bucharest, Romania
| | - Iancu Emil Pleşea
- Pathology Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania;
| | - Anwar Erchid
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
| | - Valentin Titus Grigorean
- 10th Clinical Department—General Surgery, Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (I.S.C.); (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (R.C.V.); (C.B.); (C.G.F.); (A.E.)
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Cairl NS, Orelaru F, Golden R. Fournier's Gangrene Secondary to Perforated Sigmoid Adenocarcinoma Within an Incarcerated Inguinal Hernia. Cureus 2023; 15:e49449. [PMID: 38152815 PMCID: PMC10751226 DOI: 10.7759/cureus.49449] [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: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
Colon cancer is the third most common cancer worldwide. Approximately one-fifth of colon cancers will present emergently due to obstruction or perforation. Necrotizing soft tissue infection is a rare presentation of perforated colon cancer and represents a surgical emergency due to high mortality rate. A man in his 80s presented with several days of scrotal pain and weakness. On physical exam he was found to have scrotal edema and erythema and bilateral inguinal hernias. Imaging revealed a large scrotal abscess and concern for necrotizing soft tissue infection. He was taken to the operating room for surgical debridement and exploration and was discovered to have perforated colon within an incarcerated inguinal hernia. He underwent exploratory laparotomy with sigmoid resection and end colostomy creation. Pathology returned demonstrating invasive sigmoid adenocarcinoma. Fournier's gangrene requires a high index of suspicion. It is a rapidly progressing infection associated with high mortality. Early initiation of antibiotics and surgical debridement are mainstays of treatment. When associated with perforated colonic malignancy, workup must include imaging of the chest, abdomen, and pelvis as well as carcinoembryonic antigen (CEA) level to complete staging. Fournier's gangrene secondary to perforated sigmoid adenocarcinoma is a unique presentation. Treatment first involves antibiotics and aggressive surgical debridement. Once the patient is stabilized, further oncologic workup should be completed to determine treatment course.
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Affiliation(s)
| | - Felix Orelaru
- General Surgery, Trinity Health Ann Arbor, Ann Arbor, USA
| | - Roy Golden
- Trauma, Acute and Critical Care Surgery, Trinity Health Ann Arbor, Ann Arbor, USA
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Bin Traiki TA, AlShammari SA, AlRabah RN, AlZahrani AM, Alshenaifi ST, Alhassan NS, Abdulla MH, Zubaidi AM, Al-Obeed OA, Alkhayal KA. Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience. Saudi J Gastroenterol 2023; 29:316-322. [PMID: 37006086 PMCID: PMC10644994 DOI: 10.4103/sjg.sjg_31_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection. Methods All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups. Results A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively. Conclusion Elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first two years after curative resection.
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Affiliation(s)
- Thamer A. Bin Traiki
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman A. AlShammari
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Saud T. Alshenaifi
- Department of Anesthesia, National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura S. Alhassan
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Maha-Hamadien Abdulla
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad M. Zubaidi
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Omar A. Al-Obeed
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khayal A. Alkhayal
- Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Kang S, McLeod SL, Walsh C, Grewal K. Patient outcomes associated with cancer diagnosis through the emergency department: A systematic review. Acad Emerg Med 2023; 30:955-962. [PMID: 36692950 DOI: 10.1111/acem.14671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Many patients are initially diagnosed with a new suspected cancer through the emergency department (ED). The objective of this systematic review was to compare stage of cancer and survival of patients diagnosed with cancer through the ED to patients diagnosed elsewhere. METHODS Electronic searches of Medline and EMBASE were conducted and reference lists were hand-searched. Studies comparing adult patients diagnosed with any type of cancer through the ED (ED diagnosis) to patients diagnosed elsewhere (non-ED diagnosis) were included. Two reviewers independently screened titles and abstracts, assessed quality of the studies, and extracted data. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Data pertaining to patient outcomes were summarized and pooled using random-effects models and reported as risk ratios (RRs) with 95% confidence intervals (CIs), where applicable. RESULTS Fourteen studies were included. There was an increased risk of more advanced/later stage cancer (Stage III/IV or late-stage vs. earlier stage) among patients with an ED diagnosis of cancer compared to a non-ED diagnosis of cancer (RR 1.30, 95% CI 1.39-1.58). Survival was lower for patients with an ED diagnosis of cancer compared to those diagnosed elsewhere (RR 0.61, 95% CI 0.49-0.75). CONCLUSIONS Patients with an ED diagnosis of cancer had more advanced/late stage of cancer at diagnosis and worse survival compared to patients diagnosed elsewhere. Future research examining patients diagnosed with cancer through the ED is required.
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Affiliation(s)
- Sally Kang
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Library Services, Sinai Health, Toronto, Ontario, Canada
| | - Keerat Grewal
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bass GA, Kaplan LJ, Ryan ÉJ, Cao Y, Lane-Fall M, Duffy CC, Vail EA, Mohseni S. The snapshot audit methodology: design, implementation and analysis of prospective observational cohort studies in surgery. Eur J Trauma Emerg Surg 2023; 49:5-15. [PMID: 35840703 PMCID: PMC10606835 DOI: 10.1007/s00068-022-02045-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE For some surgical conditionns and scientific questions, the "real world" effectiveness of surgical patient care may be better explored using a multi-institutional time-bound observational cohort assessment approach (termed a "snapshot audit") than by retrospective review of administrative datasets or by prospective randomized control trials. We discuss when this might be the case, and present the key features of developing, deploying, and assessing snapshot audit outcomes data. METHODS A narrative review of snapshot audit methodology was generated using the Scale for the Assessment of Narrative Review Articles (SANRA) guideline. Manuscripts were selected from domains including: audit design and deployment, statistical analysis, surgical therapy and technique, surgical outcomes, diagnostic testing, critical care management, concomitant non-surgical disease, implementation science, and guideline compliance. RESULTS Snapshot audits all conform to a similar structure: being time-bound, non-interventional, and multi-institutional. A successful diverse steering committee will leverage expertise that includes clinical care and data science, coupled with librarian services. Pre-published protocols (with specified aims and analyses) greatly helps site recruitment. Mentored trainee involvement at collaborating sites should be encouraged through manuscript contributorship. Current funding principally flows from medical professional organizations. CONCLUSION The snapshot audit approach to assessing current care provides insights into care delivery, outcomes, and guideline compliance while generating testable hypotheses.
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Affiliation(s)
- Gary A Bass
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA.
- Division of Trauma and Emergency Surgery, Orebro University Hospital and Faculty of School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISC-LDI), University of Pennsylvania, Philadelphia, PA, USA.
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 3400 Spruce St, 5 Dulles, Philadelphia, PA, 19104, USA.
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
| | - Éanna J Ryan
- Division of Trauma and Emergency Surgery, Orebro University Hospital and Faculty of School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Yang Cao
- Department of Clinical Epidemiology and Biostatistics, Orebro University, Orebro, Sweden
| | - Meghan Lane-Fall
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISC-LDI), University of Pennsylvania, Philadelphia, PA, USA
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 3400 Spruce St, 5 Dulles, Philadelphia, PA, 19104, USA
- Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA, 19104, USA
| | - Caoimhe C Duffy
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISC-LDI), University of Pennsylvania, Philadelphia, PA, USA
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 3400 Spruce St, 5 Dulles, Philadelphia, PA, 19104, USA
- Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA, 19104, USA
| | - Emily A Vail
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISC-LDI), University of Pennsylvania, Philadelphia, PA, USA
- Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 3400 Spruce St, 5 Dulles, Philadelphia, PA, 19104, USA
- Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA, 19104, USA
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Orebro University Hospital and Faculty of School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
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The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study. Healthcare (Basel) 2022; 10:healthcare10091693. [PMID: 36141305 PMCID: PMC9498868 DOI: 10.3390/healthcare10091693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan−Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50−69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan−Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56−7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89−7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71−19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99−5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49−5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.
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Shinde RS, Gupta A, Patil P, Desouza A, Ostwal V, Engineer R, Saklani A. Impact of Lumen Occlusion on Outcomes in Locally Advanced Rectal Adenocarcinoma. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Statin therapy and its association with long-term survival after colon cancer surgery. Surgery 2021; 171:890-896. [PMID: 34507829 DOI: 10.1016/j.surg.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 08/01/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND The current study aims to address the clinical equipoise regarding the association of ongoing statin therapy at time of surgery with long-term postoperative mortality rates after elective, curative, surgical resections of colon cancer by analyzing data from a large validated national register. METHODS All adults with stage I to III colon cancer who underwent elective surgery with curative intent between January 2007 and October 2016 were retrieved from the Swedish Colorectal Cancer Register, a prospectively collected national register. Patients were identified as having ongoing statin therapy if they filled a prescription within 12 months pre- and postoperatively. Study outcomes included 5-year all-cause and cancer-specific postoperative mortality. To reduce the impact of confounding from covariates owing to nonrandomization, the inverse probability of treatment weighting method was used. Subsequently, Cox proportional hazards models were fitted to the weighted cohorts. RESULTS In total, 19,118 patients underwent elective surgery for colon cancer in the specified period, of whom 31% (5,896) had ongoing statin therapy. Despite being older, having a higher preoperative risk, and having more comorbidities, patients with statin therapy had a higher postoperative survival. After inverse probability of treatment weighting, patients with statin therapy displayed a significantly lower mortality risk up to 5 years after surgery for both all-cause (hazard ratio 0.68, 95% confidence interval 0.63-0.74, P < .001) and cancer-specific mortality (hazard ratio 0.76, 95% confidence interval 0.66-0.89, P < .001). CONCLUSION The results of this study indicate that statin therapy is associated with a sustained reduction in all-cause and cancer-specific mortality up to 5 years after elective colon cancer surgery. The findings warrant validation in future prospective clinical trials.
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Bass GA, Forssten M, Pourlotfi A, Ahl Hulme R, Cao Y, Matthiessen P, Mohseni S. Cardiac risk stratification in emergency resection for colonic tumours. BJS Open 2021; 5:6316195. [PMID: 34228103 PMCID: PMC8259498 DOI: 10.1093/bjsopen/zrab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Despite advances in perioperative care, the postoperative mortality rate after emergency oncological colonic resection remains high. Risk stratification may allow targeted perioperative optimization and cardiac risk stratification. This study aimed to test the hypothesis that the Revised Cardiac Risk Index (RCRI), a user-friendly tool, could identify patients who would benefit most from perioperative cardiac risk mitigation. Methods Patients who underwent emergency resection for colonic cancer from 2007 to 2017 and registered in the Swedish Colorectal Cancer Registry (SCRCR) were analysed retrospectively. These patients were cross-referenced by social security number to the Swedish National Board of Health and Welfare data set, a government registry of mortality, and co-morbidity data. RCRI scores were calculated for each patient and correlated with 90-day postoperative mortality risk, using Poisson regression with robust error of variance. Results Some 5703 patients met the study inclusion criteria. A linear increase in crude 90-day postoperative mortality was detected with increasing RCRI score (37.3 versus 11.3 per cent for RCRI 4 or more versus RCRI 1; P < 0.001). The adjusted 90-day all-cause mortality risk was also significantly increased (RCRI 4 or more versus RCRI 1: adjusted incidence rate ratio 2.07, 95 per cent c.i. 1.49 to 2.89; P < 0.001). Conclusion This study documented an association between increasing cardiac risk and 90-day postoperative mortality. Those undergoing emergency colorectal surgery for cancer with a raised RCRI score should be considered high-risk patients who would most likely benefit from enhanced postoperative monitoring and critical care expertise.
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Affiliation(s)
- G A Bass
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - M Forssten
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - A Pourlotfi
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - R Ahl Hulme
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Y Cao
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - P Matthiessen
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - S Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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12
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Pourlotfi A, Ahl R, Sjolin G, Forssten MP, Bass GA, Cao Y, Matthiessen P, Mohseni S. Statin therapy and postoperative short-term mortality after rectal cancer surgery. Colorectal Dis 2021; 23:875-881. [PMID: 33305498 PMCID: PMC8246857 DOI: 10.1111/codi.15481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to assess the correlation between regular statin therapy and postoperative mortality following surgical resection for rectal cancer. METHOD This retrospective cohort study included all adult patients undergoing abdominal rectal cancer surgery in Sweden between January 2007 and September 2016. Data were gathered from the Swedish Colorectal Cancer Registry, a large population-based prospectively collected registry. Statin users were defined as patients with one or more collected prescriptions of a statin within 12 months before the date of surgery. The statin-positive and statin-negative cohorts were matched by propensity scores based on baseline demographics. RESULTS A total of 11 966 patients underwent surgical resection for rectal cancer, of whom 3019 (25%) were identified as statin users. After applying propensity score matching (1:1), 3017 pairs were available for comparison. In the matched groups, statin users demonstrated reduced 90-day all-cause mortality (0.7% vs. 5.5%, p < 0.001) and also showed significantly reduced cause-specific mortality due to cardiovascular and respiratory events, as well as sepsis and multiorgan failure. The significant postoperative survival benefit of statin users was seen despite a higher rate of cardiovascular comorbidity. CONCLUSION Preoperative statin therapy displays a strong association with reduced postoperative mortality following surgical resection for rectal cancer. The results from the current study warrant further investigation to determine whether a causal relationship exists.
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Affiliation(s)
- Arvid Pourlotfi
- Division of Trauma & Emergency Surgery, Department of SurgeryOrebro University HospitalOrebroSweden,School of Medical SciencesOrebro UniversityOrebroSweden
| | - Rebecka Ahl
- School of Medical SciencesOrebro UniversityOrebroSweden,Division of SurgeryDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | - Gabriel Sjolin
- Division of Trauma & Emergency Surgery, Department of SurgeryOrebro University HospitalOrebroSweden,School of Medical SciencesOrebro UniversityOrebroSweden
| | - Maximilian Peter Forssten
- Division of Trauma & Emergency Surgery, Department of SurgeryOrebro University HospitalOrebroSweden,School of Medical SciencesOrebro UniversityOrebroSweden
| | - Gary A. Bass
- School of Medical SciencesOrebro UniversityOrebroSweden,Surgical Critical Care and Emergency SurgeryPenn MedicinePenn Presbyterian Medical CenterPAUSA
| | - Yang Cao
- Clinical Epidemiology and BiostatisticsSchool of Medical SciencesOrebro UniversityOrebroSweden
| | - Peter Matthiessen
- Division of Trauma & Emergency Surgery, Department of SurgeryOrebro University HospitalOrebroSweden,School of Medical SciencesOrebro UniversityOrebroSweden
| | - Shahin Mohseni
- Division of Trauma & Emergency Surgery, Department of SurgeryOrebro University HospitalOrebroSweden,School of Medical SciencesOrebro UniversityOrebroSweden
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13
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Azin A, Hirpara DH, Draginov A, Khorasani M, Patel SV, O'Brien C, Quereshy FA, Chadi SA. Adequacy of lymph node harvest following colectomy for obstructed and nonobstructed colon cancer. J Surg Oncol 2020; 123:470-478. [PMID: 33141434 DOI: 10.1002/jso.26274] [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] [Received: 08/24/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Technical and clinical differences in resection of obstructed and non-obstructed colon cancers may result in differences in lymph node retrieval. The objective of this study is to compare the lymph node harvest following resection of obstructed and nonobstructed colon cancer patients. METHODS A retrospective analysis utilizing the 2014-2018 NSQIP colectomy targeted data set was conducted. One-to-one coarsened exact matching (CEM) was utilized between patients undergoing resection for obstructed and non-obstructed colon cancer. The primary outcome was the adequacy of lymph node retrieval (LNR, ≥12 nodes). RESULTS CEM resulted in 9412 patients. Patients with obstructed tumors were more likely to have inadequate LNR (13.3% vs 8.2%, p < .001) compared to those with nonobstructed tumors. Multivariate analysis demonstrated that patients with obstructing tumors had worse LNR compared to non-obstructed tumors (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.62-0.87; p < .005). Increased age (OR: 0.99, 95% CI: 0.098-0.99), presence of preoperative sepsis (OR: 0.70, 95% CI: 0.055-0.90), left-sided and sigmoid tumors compared to right-sided (OR: 0.64, 95% CI: 0.51-0.81; OR: 0.69, 95% CI: 0.58-0.82, respectively), and open surgical resection compared to an minimally invasive surgical approach were associated with inadequate LNR (p < .05). CONCLUSION This study demonstrated that resection for obstructing colon cancer compared to non-obstructed colon cancer is associated with increased odds of inadequate lymph node harvest.
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Affiliation(s)
- Arash Azin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arman Draginov
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Sunil V Patel
- Division of General Surgery, Queens University, Kingston, Ontario, Canada
| | - Catherine O'Brien
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sami A Chadi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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14
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Lam J, Chauhan V, Lam I, Kannappa L, Salama Y. Colorectal stenting in England: a cross-sectional study of practice. Ann R Coll Surg Engl 2020; 102:451-456. [PMID: 32347738 DOI: 10.1308/rcsann.2020.0077] [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: 12/21/2022] Open
Abstract
INTRODUCTION UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. METHODS All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). RESULTS Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. CONCLUSIONS All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.
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Affiliation(s)
- J Lam
- Kettering General Hospital NHS Foundation Trust, UK
| | - V Chauhan
- Kettering General Hospital NHS Foundation Trust, UK
| | - I Lam
- University of Nottingham, UK
| | - L Kannappa
- Kettering General Hospital NHS Foundation Trust, UK
| | - Y Salama
- Kettering General Hospital NHS Foundation Trust, UK
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15
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Bergvall M, Skullman S, Kodeda K, Larsson P. Better survival for patients with colon cancer operated on by specialized colorectal surgeons - a nationwide population-based study in Sweden 2007-2010. Colorectal Dis 2019; 21:1379-1386. [PMID: 31293019 PMCID: PMC6916325 DOI: 10.1111/codi.14760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
AIM Mortality and complication rates after surgery for colon cancer are high, especially after emergency procedures. The aim of the present study was to evaluate the importance of the formal competence of surgeons for survival and morbidity. METHOD The Swedish Colorectal Cancer Registry prospectively records data on patients diagnosed with cancer within the colon and rectum. A cohort of patients operated on for colon cancer between 2007 and 2010 were followed 5 years after surgery. Data on postoperative morbidity, mortality and long-term survival were compared with regard to formal competency of the most senior surgeon attending the procedure. RESULTS This analysis includes 13 365 patients operated on for colon cancer, including 10 434 elective procedures and 2931 emergency cases. The overall 5-year survival was higher for those operated on by subspecialist colorectal surgeons compared with general surgeons (60% vs 48%; P < 0.001). Five-year survival after elective surgery was 63% vs 55% (P < 0.001) and 35% vs 31% (P < 0.05) after emergency procedures when performed by colorectal surgeons compared with general surgeons. Postoperative 30-day mortality was 3% after surgery performed by colorectal surgeons compared with 7% when performed by general surgeons. Mortality at 90 days was 6% after surgery performed by colorectal surgeons compared with 11% for patients operated on by general surgeons (P < 0.001). CONCLUSION Subspecialization in colorectal surgery is associated with better outcome for patients operated on for colon cancer, and effort should be made to increase the availability of colorectal surgeons for both acute and elective colon cancer surgery.
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Affiliation(s)
- M. Bergvall
- Department of SurgerySkaraborgs Sjukhus Research CentreSkaraborgs Sjukhus SkövdeSkövdeSweden
| | - S. Skullman
- Department of SurgerySkaraborgs Sjukhus Research CentreSkaraborgs Sjukhus SkövdeSkövdeSweden
| | - K. Kodeda
- Department of SurgeryTaranaki Base HospitalNew PlymouthNew Zealand,Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - P.‐A. Larsson
- Department of SurgerySkaraborgs Sjukhus SkövdeSkövdeSweden,Department of Clinical SciencesLund UniversityLundSweden
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16
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Lavanchy JL, Vaisnora L, Haltmeier T, Zlobec I, Brügger LE, Candinas D, Schnüriger B. Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis 2019; 34:2091-2099. [PMID: 31709491 DOI: 10.1007/s00384-019-03426-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) are discussed controversially. This study aims to assess long-term outcomes of emergency versus elective CRC surgery. METHODS Single-center retrospective cohort study. Patients undergoing emergency or elective CRC surgery from July 2002 to January 2013 were included. Primary outcome was 5-year survival, secondary outcomes were in-hospital mortality and local tumor recurrence. RESULTS Overall, 475 patients were included. Median age was 69.0 (IQR 59.0-77.0) years. A total of 141 patients (30%) were operated for rectal cancer and 334 patients (70%) for colon cancer. Median follow-up was 445 (IQR 67-1409) days. Emergency resection was performed in 105 patients (22%) due to obstruction, perforation, or bleeding. Stage IV tumors and ASA scores≥ 3 were significantly more frequent in the emergency than in the elective resection group (39.0% vs. 33.5%, p < 0.001; 75.5% vs. 61.3%, p = 0.003). The rate of patients with positive lymph nodes was similar in the two groups (46.2% vs. 46.3%, p = 1.000). In-hospital mortality was significantly higher in the emergency CRC versus the elective CRC group (8.4% vs. 3.0%, p = 0.023). Five-year survival (aHR 1.38; 95%CI 0.81-2.37, p = 0.237) or local tumor recurrence (aHR 1.48; 95%CI 0.47-4.66, p = 0.500) were not significantly different in patients undergoing emergency versus elective surgery for CRC. CONCLUSION In-hospital mortality was increased in emergency versus elective CRC resections. However, 5-year survival and local recurrence after surgery for CRC were determined by the tumor stage, and not by the emergency versus elective setting of surgical resection.
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Affiliation(s)
- Joël L Lavanchy
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Vaisnora
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Haltmeier
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Lukas E Brügger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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17
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Téllez T, García-Aranda M, Zarcos-Pedrinaci I, Rivas-Ruiz F, Pérez Ruiz E, Padilla-Ruiz MDC, Baré ML, Morales-Suárez-Varela M, Rueda A, Alcaide J, Redondo Bautista M. First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:750-756. [PMID: 31345043 DOI: 10.17235/reed.2019.5777/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. METHODS the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. RESULTS colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. CONCLUSIONS hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Julia Alcaide
- Departamento de Hematología y Oncología, Hospital Costa del Sol
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18
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“-Omas” presenting as “-itis”: acute inflammatory presentations of common gastrointestinal neoplasms. Emerg Radiol 2019; 26:433-448. [DOI: 10.1007/s10140-019-01678-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
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19
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Urgent Management of Obstructing Colorectal Cancer: Divert, Stent, or Resect? J Gastrointest Surg 2019; 23:425-432. [PMID: 30284201 DOI: 10.1007/s11605-018-3990-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
Despite the availability of effective colorectal cancer (CRC) screening strategies, up to 10% of CRC patients present with obstructive symptoms as the first sign of disease. For patients with acute or subacute malignant obstruction that requires urgent intervention, treatment options include endoscopic stenting as a bridge to surgery, one-stage surgical resection and anastomosis, or diverting ostomy which may or may not be followed by later tumor resection and stoma closure. However, to date, there is no consensus guideline for the optimal approach to manage malignant colorectal obstruction. This article aims to illustrate clinical scenarios in palliative, curative, and potentially curative settings, and delineate the key factors to be considered when making an individualized decision in order to determine the optimal treatment.
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20
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Koskenvuo L, Malila N, Pitkäniemi J, Miettinen J, Heikkinen S, Sallinen V. Sex differences in faecal occult blood test screening for colorectal cancer. Br J Surg 2018; 106:436-447. [PMID: 30460999 PMCID: PMC6587743 DOI: 10.1002/bjs.11011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
Background This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness. Methods In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed. Results From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women. Conclusion Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes. Only of benefit in men
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Affiliation(s)
- L Koskenvuo
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - J Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Miettinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - S Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - V Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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21
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Wanis KN, Ott M, Van Koughnett JAM, Colquhoun P, Brackstone M. Long-term oncological outcomes following emergency resection of colon cancer. Int J Colorectal Dis 2018; 33:1525-1532. [PMID: 29946860 DOI: 10.1007/s00384-018-3109-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The relationship between emergency colon cancer resection and long-term oncological outcomes is not well understood. Our objective was to characterize the impact of emergency resection for colon cancer on disease-free and overall patient survival. METHODS Data on patients undergoing resection for colon cancer from 2006 to 2015 were collected from a prospectively maintained clinical and administrative database. The median follow-up time was 4.4 years. Cox proportional hazards models were used to estimate the hazard ratios for recurrence and death for patients treated with surgery for an emergent presentation. Differences in initiation of, and timeliness of, adjuvant chemotherapy between emergently and electively treated patients were also examined. RESULTS Of the 1180 patients who underwent resection for stages I, II, or III colon cancer, 158 (13%) had emergent surgery. After adjustment for patient, tumor, and treatment characteristics, the HR for recurrence was 1.64 (95% CI 1.12-2.40) and for death was 1.47 (95% CI 1.10-1.97). After adjustment for tumor characteristics, patients who underwent emergency resection were similarly likely to receive adjuvant chemotherapy (OR 1.1; 95% CI 0.70-1.76). The time from surgery to initiation of adjuvant chemotherapy was also similar between the groups. CONCLUSIONS Emergency surgery for localized or regional colon cancer is associated with a greater risk of recurrence and death. This association does not appear to be due to differences in adjuvant treatment. A focus on screening and colon cancer awareness in order to reduce emergency presentations is warranted.
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Affiliation(s)
- Kerollos Nashat Wanis
- Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, N6A 5A5, Canada.
| | - Michael Ott
- Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, N6A 5A5, Canada
| | - Julie Ann M Van Koughnett
- Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, N6A 5A5, Canada
| | - Patrick Colquhoun
- Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, N6A 5A5, Canada
| | - Muriel Brackstone
- Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, N6A 5A5, Canada
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22
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Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, Agresta F, Allievi N, Bellanova G, Coccolini F, Coy C, Fugazzola P, Martinez CA, Montori G, Paolillo C, Penachim TJ, Pereira B, Reis T, Restivo A, Rezende-Neto J, Sartelli M, Valentino M, Abu-Zidan FM, Ashkenazi I, Bala M, Chiara O, De' Angelis N, Deidda S, De Simone B, Di Saverio S, Finotti E, Kenji I, Moore E, Wexner S, Biffl W, Coimbra R, Guttadauro A, Leppäniemi A, Maier R, Magnone S, Mefire AC, Peitzmann A, Sakakushev B, Sugrue M, Viale P, Weber D, Kashuk J, Fraga GP, Kluger I, Catena F, Ansaloni L. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018; 13:36. [PMID: 30123315 PMCID: PMC6090779 DOI: 10.1186/s13017-018-0192-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
ᅟ Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value. Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required. Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
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Affiliation(s)
- Michele Pisano
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Luigi Zorcolo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Cecilia Merli
- Unit of Emergency Medicine Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | | | - Elia Poiasina
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Marco Ceresoli
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | | | - Niccolò Allievi
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | - Federico Coccolini
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | - Claudio Coy
- 9Colorectal Unit, Campinas State University, Campinas, SP Brazil
| | - Paola Fugazzola
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | | | - Ciro Paolillo
- Emergency Department Udine Healthcare and University Integrated Trust, Udine, Italy
| | | | - Bruno Pereira
- 14Department of Surgery, University of Campinas, Campinas, Brazil
| | - Tarcisio Reis
- Oncology Surgery and Intensive Care, Oswaldo Cruz Hospital, Recife, Brazil
| | - Angelo Restivo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Joao Rezende-Neto
- 16Department of Surgery Division of General Surgery, University of Toronto, Toronto, Canada
| | | | - Massimo Valentino
- 18Radiology Unit Emergency Department, S. Antonio Abate Hospital, Tolmezzo, UD Italy
| | - Fikri M Abu-Zidan
- 19Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Miklosh Bala
- 21Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | | | - Nicola De' Angelis
- 22Unit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor Hospital, Créteil, France
| | - Simona Deidda
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Belinda De Simone
- Department of General and Emergency Surgery Cannes' Hospital Cannes, Cedex, Cannes, France
| | | | - Elena Finotti
- Department of General Surgery ULSS5 del Veneto, Adria, (RO) Italy
| | - Inaba Kenji
- 25Division of Trauma & Critical Care University of Southern California, Los Angeles, USA
| | - Ernest Moore
- 26Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Steven Wexner
- Digestive Disease Center, Department of Colorectal Surgery Cleveland Clinic Florida, Tallahassee, USA
| | - Walter Biffl
- 28Acute Care Surgery The Queen's Medical Center, Honolulu, HI USA
| | - Raul Coimbra
- 29Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, USA
| | - Angelo Guttadauro
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | - Ari Leppäniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Stefano Magnone
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Alain Chicom Mefire
- 32Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Andrew Peitzmann
- 33Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Boris Sakakushev
- 34General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Dieter Weber
- 37Trauma and General Surgeon, Royal Perth Hospital, Perth, Australia
| | - Jeffry Kashuk
- 38Surgery and Critical Care Assuta Medical Centers, Tel Aviv, Israel
| | - Gustavo P Fraga
- 39Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Ioran Kluger
- 40Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
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Ahmadinejad M, Pouryaghobi SM, Bayat F, Bolvardi E, Chokan NMJ, Masoumi B, Ahmadi K. Surgical outcome and clinicopathological characteristics of emergency presentation elective cases of colorectal cancer. Arch Med Sci 2018; 14:826-829. [PMID: 30002700 PMCID: PMC6040124 DOI: 10.5114/aoms.2016.61706] [Citation(s) in RCA: 3] [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: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the significance of clinicopathological characteristics of colorectal cancer patients undergoing emergency and elective surgery. MATERIAL AND METHODS In total, 116 tumors from patients treated surgically for colorectal cancer at four hospitals in Tehran between 2008 and 2013 were analyzed in the current study. RESULTS Our findings revealed that the emergency cases were significantly more likely to have an advanced TNM stage (p = 0.027) and histologic grade (p = 0.01) compared with the elective patients. Furthermore, the nature of surgery was significantly associated with vascular and perineural invasion (p = 0.021; p = 0.001). We also evaluated the association of gender, age, and tumor location with the nature of surgical presentation. However, no association was found between these parameters and the nature of surgery. Emergency was also correlated with greater length of hospital stay and higher rate of admission to the intensive care unit. The mortality rate was 20% in emergency cases, while patients with elective surgery had 5.63% perioperative mortality (p = 0.001). The emergency patients had a higher rate of mortality. CONCLUSIONS Our data indicated that colorectal cancer patients undergoing emergency surgery showed an advanced stage. The emergency patients had a higher rate of mortality than elective cases.
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Affiliation(s)
| | | | - Fatemeh Bayat
- Department of Anesthesiology, Alborz University of Medical Sciences, Karaj, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Babak Masoumi
- Emergency Medicine Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Albalawi IA, Abdullah AA, Mohammed ME. Emergency presentation of colorectal cancer in Northwestern Saudi Arabia. Saudi Med J 2018; 38:528-533. [PMID: 28439604 PMCID: PMC5447215 DOI: 10.15537/smj.2017.5.17719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To investigate the frequency and clinical characteristics of emergency presentation of colorectal carcinoma (CRC) in Tabuk Region of Saudi Arabia. Methods: This is a retrospective, descriptive hospital-based study. All cases with CRC that presented to the main referral hospitals in Tabuk, Saudi Arabia between 2010 and 2015 were retrieved. The relevant hospitals are: King Salman Military Hospital, King Khalid Hospital, and King Fahad Hospital. Results: Seventy-three patients were included in the study. Twenty-two patients presented emergency constituting 30.6% of the total. Emergency CRC presentation was more common in elderly patients (81.8%), but a greater proportion of young patients was also affected (40% versus 29% in elderly patients). The disease is more common in females (37%) than males (26.7%) and intestinal obstruction was the sole form of presentation. Patients presenting emergency had more right-sided (61.9%) than left-sided tumors (30.2%). Advanced presentation with metastasis was noted in 40% of the patients presenting acutely. Conclusion: Emergency CRC presentation is common in the Tabuk region. Patients tend to present at an advanced stage, which necessitates an endeavor to detect the disease in its early stages, possibly through initiation of health education programs and suitable screening projects.
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Affiliation(s)
- Ibrahim A Albalawi
- Faculty of Medicine, University of Tabuk, Tabuk, Kingdom of Saudi Arabia. E-mail.
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Geraghty J, Shawihdi M, Devonport E, Sarkar S, Pearson MG, Bodger K. Reduced risk of emergency admission for colorectal cancer associated with the introduction of bowel cancer screening across England: a retrospective national cohort study. Colorectal Dis 2018; 20:94-104. [PMID: 28736972 DOI: 10.1111/codi.13822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
AIM We wanted to find out if roll-out of the bowel cancer screening programme (BCSP) across England was associated with a reduced risk of emergency hospital admission for people presenting with colorectal cancer (CRC) during this period. METHOD This is a retrospective cohort study of 27 763 incident cases of CRC over a 1-year period during the roll-out of screening across parts of England. The primary outcome was the number of emergency (unplanned) hospital admissions during the diagnostic pathway. The primary exposure was to those living in an area where the BCSP was active at the time of diagnosis. Patients were categorized into three exposure groups: BCSP not active (reference group), BCSP active < 6 months or BCSP active ≥ 6 months. RESULTS The risk of emergency admission for CRC in England was associated with increasing age, female gender, comorbidity and social deprivation. After adjusting for these factors in logistic regression, the odds ratio (OR) for emergency admission in patients diagnosed ≥ 6 months after the start-up of local screening was 0.83 (CI 0.76-0.90). The magnitude of risk reduction was greatest for cases of screening age (OR 0.75; CI 0.63-0.90) but this effect was apparent also for cases outside the 60-69-year age group (OR 0.85; CI 0.77-0.94). Living in an area with active BCSP conferred no reduction in risk of emergency admission for people diagnosed with oesophagogastric cancer during the same period. CONCLUSION The start-up of bowel cancer screening in England was associated with a substantial reduction in the risk of emergency admission for CRC in people of all ages. This suggests that the roll-out of the programme had indirect benefits beyond those related directly to participation in screening.
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Affiliation(s)
- J Geraghty
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Shawihdi
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - E Devonport
- Aintree Health Outcomes Partnership, Aintree University Hospital, Liverpool, UK
| | - S Sarkar
- Gastroenterology Department, Royal Liverpool Hospital, Liverpool, UK
| | - M G Pearson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Bodger
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Kozak VN, Khorana AA, Amarnath S, Glass KE, Kalady MF. Multidisciplinary Clinics for Colorectal Cancer Care Reduces Treatment Time. Clin Colorectal Cancer 2017; 16:366-371. [DOI: 10.1016/j.clcc.2017.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023]
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Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis. Int J Colorectal Dis 2017; 32:1453-1461. [PMID: 28755242 DOI: 10.1007/s00384-017-2864-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE About 30% of colorectal cancers (CRCs) present with acute symptoms. The adequacy of oncologic resections is a matter of concern since few authors reported that emergency surgery in these patients results in a lower lymph node harvest (LNH). In addition, emergency resections have been reported with a longer hospital stay and higher morbidity rate. We thus conducted a propensity score-matched analysis with the aim of investigating LNH in emergency specimens comparing with elective ones. Secondary aim was the comparison of morbidity and hospital stay. METHODS Eighty-seven consecutive R0 emergency surgical procedures were matched with elective CRCs using the propensity score method and the following covariates: age, sex, stage, and localization. Groups were compared using univariate and multivariate analyses. Outcome measures were LNH, nodal ratio, Clavien's morbidity grades, and hospital stay. RESULTS Emergency patients presented more metastatic nodes compared with elective ones (p 0.017); however, both presented a comparable mean LNH. Multivariate analysis documented that a T stage ≥3 was the only variable correlated with a nodal positivity (OR 6.3). On univariate analysis, emergency CRCs had a longer mean hospital stay compared with elective resections (p 0.006) and a higher rate of Clavien ≥4 events (p 0.0173). Finally, emergency resection and an age >66 years were variables independently correlated with a mean hospital stay >10 days (OR, respectively, 3.7 and 3.5). CONCLUSIONS Emergency CRC resections were equivalent to the elective procedures with respect to LNH. However, emergency surgery correlated with a longer mean hospital stay. Graphical abstract Emergency and Elective resections for CRC provide similar LNH.
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Abstract
Many colorectal carcinomas will present emergently with issues such as obstruction, perforation, and bleeding. Emergency surgery is associated with poor short- and long-term outcomes. For abnormality localizing to the colon proximal to the splenic flexure, surgical management with hemicolectomy is often a safe and appropriate approach. Obstructions are more common in the distal colon, however, where there is an evolving spectrum of surgical and nonsurgical options, most notably by the development of endoluminal stents. Perforation and bleeding are managed similarly to benign causes, as malignancy may be only part of a differential diagnosis at the time of an operation.
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Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ. Emergent Colectomy Is Independently Associated with Decreased Long-Term Overall Survival in Colon Cancer Patients. J Gastrointest Surg 2017; 21:543-553. [PMID: 28083841 DOI: 10.1007/s11605-017-3355-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to examine the long-term overall survival (OS) of colon cancer patients who underwent emergent resection versus patients who were resected electively. METHODS The 2006-2012 National Cancer Data Base was queried for colon cancer patients who underwent surgical resection. Emergent resection was defined as resection within 24 h of diagnosis. A mixed-effects logistic regression was used to estimate the effect of emergent resection on 30- and 90-day mortality. A propensity score-matched mixed-effects Cox proportional-hazards model was used to estimate the effect of emergent resection on 5-year OS. RESULTS Two hundred fourteen thousand one hundred seventy-four patients met inclusion criteria, 30% of the cohort had an emergent resection. After controlling for patient and hospital factors, pathological stage, lymph node yield, margin status, and adjuvant chemotherapy, emergent resection was associated with increased odds of 30-day mortality (OR = 1.69, 95% CI = 1.60, 1.78) and hazard of death at 5 years (HR = 1.13, 95% CI = 1.09, 1.15) compared to elective resections. CONCLUSION Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year OS compared to elective resection. With 30% of cases in this study emergent, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections.
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Affiliation(s)
- Zhaomin Xu
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA.
| | - Adan Z Becerra
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher T Aquina
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Bradley J Hensley
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Carla F Justiniano
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Courtney Boodry
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Alex A Swanger
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Reza Arsalanizadeh
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, State University of New York at Buffalo, School of Public Health and Health Professions, Buffalo, NY, USA
| | - John R Monson
- Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
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You YN, Eng C, Aloia T. Multidisciplinary management of stage IV colon cancer. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kundes F, Kement M, Cetin K, Kaptanoglu L, Kocaoglu A, Karahan M, Yegen SF, Atici AE, Civil O, Eser M, Cakir T, Bildik N. Evaluation of the patients with colorectal cancer undergoing emergent curative surgery. SPRINGERPLUS 2016; 5:2024. [PMID: 27995001 PMCID: PMC5125280 DOI: 10.1186/s40064-016-3725-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022]
Abstract
Background The aim of our study is to evaluate perioperative and mid-term oncologic outcomes of the patients with colorectal cancer, who underwent emergent curative surgery. Methods The study included all patients with colorectal cancer, who underwent surgery for curative intent between 1 January 2012 and 31 December 2014 in General Surgery Department of Kartal Training and Research Hospital. The patients were divided into two groups according to the type of admission (emergent or elective). The data of the patients were retrospectively collected with chart review. Demographic characteristics of the patients, ASA scores, emergent indications and surgical interventions, postoperative complications, pathological findings, oncological therapy, and follow-up findings were investigated. Results Fifty-one and 209 patients were evaluated in both groups, respectively. Rate of right sided and sigmoid/recto-sigmoid tumors were significantly higher in emergent group. Ostomy rate, early morbidity, ICU need, transfusion, and mortality rates in emergent group were significantly higher than elective group. Average length of hospital stay in emergent group was also significantly longer in elective group (11.2 ± 3.2 vs. 8.4 ± 2.4 days). The patients in emergent group had a much lower survival rate than those in elective group. Conclusion In our study, emergency presentation of colorectal cancer was found associated with increased morbidity, a longer length of stay, increased in-hospital mortality, advanced pathologic stage and worsened long term survival in even same stages.
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Affiliation(s)
- Fikri Kundes
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Metin Kement
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Kenan Cetin
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Levent Kaptanoglu
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Aytaç Kocaoglu
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Karahan
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Serkan Fatih Yegen
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ali Emre Atici
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Osman Civil
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Eser
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Tebessum Cakir
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Nejdet Bildik
- Department of General Surgery, University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey
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Abstract
Twenty percent of colon cancers present as an emergency. However, the association between emergency presentation and disease-free survival (DFS) remains uncertain. Consecutive patients who underwent elective (CC) and emergent (eCC) resection for colon cancer were included in the analysis. Survival outcomes were compared between the 2 groups in univariate/multivariate analyses. A total of 439 patients underwent colonic resection for colon cancer during the interval 2000-2010; 97 (22.1%) presented as an emergency. eCC tumors were more often located at the splenic flexure (P = 0.017) and descending colon (P = 0.004). The eCC group displayed features of more advanced disease with a higher proportion of T4 (P = 0.009), N2 tumors (P < 0.01) and lymphovascular invasion (P< 0.01). eCC was associated with adverse locoregional recurrence (P = 0.02) and adverse DFS (P < 0.01 ) on univariate analysis. eCC remained an independent predictor of adverse locoregional recurrence (HR 1.86, 95% CI 1.50-3.30, P = 0.03) and DFS (HR 1.30, 95% CI 0.88-1.92, P = 0.05) on multivariate analysis. eCC was not associated with adverse overall survival and systemic recurrence. eCC is an independent predictor of adverse locoregional recurrence and DFS.
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ELHadi A, Ashford-Wilson S, Brown S, Pal A, Lal R, Aryal K. Effect of Social Deprivation on the Stage and Mode of Presentation of Colorectal Cancer. Ann Coloproctol 2016; 32:128-32. [PMID: 27626022 PMCID: PMC5019964 DOI: 10.3393/ac.2016.32.4.128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/23/2016] [Indexed: 01/29/2023] Open
Abstract
Purpose Based in a hospital serving one of the most deprived areas in the United Kingdom (UK), we aimed to investigate, using the Indices of Deprivation 2010, the hypothesis that deprivation affects the stage and mode of presentation of colorectal cancer. Methods All newly diagnosed patients with colorectal cancer presenting to a District General Hospital in the UK between January 2010 and December 2014 were included. Data were collected from the Somerset National Cancer Database. The effect of social deprivation, measured using the Index of Multiple Deprivation Score, on the stage and mode of presentation was evaluated utilizing Microsoft Excel and IBM SPSS ver. 22.0. Results A total of 701 patients (54.5% male; mean age, 76 years) were included; 534 (76.2%) underwent a surgical procedure, and 497 (70.9%) underwent a colorectal resection. Of the patients undergoing a colorectal resection, 86 (17.3%) had an emergency surgical resection. Social deprivation was associated with Duke staging (P = 0.09). The 90-day mortality in patients undergoing emergency surgery was 12.8% compared to 6.8% in patients undergoing elective surgery (P = 0.06). No association was found between deprivation and emergency presentation (P = 0.97). A logistic regression analysis showed no increase in the probability of metastasis amongst deprived patients. Conclusion This study suggests an association between deprivation and the stage of presentation of colorectal cancer. Patients undergoing emergency surgery tend to have a higher 90-day mortality rate, although this was not related to deprivation. This study highlights the need to develop an individual measure to assess social deprivation.
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Affiliation(s)
- Ahmed ELHadi
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Sarah Ashford-Wilson
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Stephanie Brown
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Atanu Pal
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Roshan Lal
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Kamal Aryal
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, UK
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Saraste D, Martling A, Nilsson PJ, Blom J, Törnberg S, Janson M. Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment. J Med Screen 2016; 24:69-74. [PMID: 27470598 DOI: 10.1177/0969141316656216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives To compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer. Methods Data on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm-Gotland screening register and the Swedish Colorectal Cancer Registry. Results The screening group had a higher proportion of stage I disease (41 vs. 15%; p < 0.001), a more complete staging of primary tumour and metastases and were more frequently multidisciplinary team-assessed than the non-screening group ( p < 0.001). In both groups, patients with endoscopically resected cancers were less completely staged and multidisciplinary team-assessed than patients with surgically resected cancers ( p < 0.001). No statistically significant differences were observed between the screening and non-screening groups in the use of neoadjuvant treatment in rectal cancer (68 vs.76%), surgical treatment with local excision techniques in stage I rectal cancer (6 vs. 9%) or adjuvant chemotherapy in stages II and III disease (46 vs. 52%). Emergency interventions for colorectal cancer occurred in 4% of screening participants vs. 11% of non-compliers. Conclusions Screening detected cancer patients were staged and multidisciplinary team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.
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Affiliation(s)
- D Saraste
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Martling
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - P J Nilsson
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Blom
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - S Törnberg
- 2 Department of Oncology-Pathology, Karolinska Institutet and Regional Cancer Centre Stockholm/Gotland, Sweden
| | - M Janson
- 3 Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Rizzuto A, Palaia I, Vescio G, Serra R, Malanga D, Sacco R. Multivisceral resection for occlusive colorectal cancer: Is it justified? Int J Surg 2016; 33 Suppl 1:S142-7. [PMID: 27398688 DOI: 10.1016/j.ijsu.2016.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The only possibility of curative surgery in primary T4, locally advanced, adherent colorectal carcinoma (LAACRC) or recurrent disease with infiltration of adjacent organs is the en bloc resection of the invaded structures to achieve clear surgical margins (R0). The role of extended resections for occlusive LAACRC remains unclear. We report on our experience on Multivisceral resections (MVR) for LAACRC patients between 2003 and 2012. METHODS Twenty-two patients, who were treated with MVR with curative purpose for non-metastatic disease were recruited. General epidemiologic data, clinical findings, surgical treatment and/or multimodal therapy, histo-pathological examination and follow-up were collected. In addition post-operative complications were classified. Patients with occlusive LAACRC (n = 6) were compared to patients with uncomplicated presentation (n = 16) defined according to the UICC classification. RESULTS No statistically significant differences were observed between the two groups, in terms of median age, gender and localization of tumors. R0 resection was performed in 14 (87.5%) patients with uncomplicated tumors and in all patients with occlusive LAACRC. R1 resection was performed in 2/16 (12.5%) patients with uncomplicated disease. No peri-operative mortality was reported in patients of both groups. In the group of uncomplicated tumors, 11 patients (68.7%) were classified as pathological (p)T4 and 5 patients (31.2%) were classified pT3 whereas in the group of occlusive LAACRC the majority of patients were classified as pT4 (83.3%). Lymph node involvement occurred in 9 patients (56.2%) of the fist group and in two patients (33.3%) of the second group, respectively. The 3-year survival rates in all patients with both uncomplicated and occlusive diseases were 58.4% and 33.3%, respectively. The 3-years survival of patients with locally advanced adherent rectal cancer was significantly lower than the observed survival of patients with colon cancer (p < 0.0001). CONCLUSION MVR offers cure (R0 resections) in uncomplicated and obstructive LAACRC with three years survival in 40% of patients. Patients affected by rectal cancer with occlusive disease showed significantly decreased survival in comparison with those affected by colon cancer.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Ilaria Palaia
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - Giuseppina Vescio
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - Donatella Malanga
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Italy
| | - Rosario Sacco
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
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Weixler B, Warschkow R, Ramser M, Droeser R, von Holzen U, Oertli D, Kettelhack C. Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 2016; 16:208. [PMID: 26968526 PMCID: PMC4787247 DOI: 10.1186/s12885-016-2239-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background It remains a matter of debate whether colorectal cancer resection in an emergency setting negatively impacts on survival. Our objective was therefore to assess the impact of urgent versus elective operation on overall and disease-free survival in patients undergoing resection for colorectal cancer by using propensity score adjusted analysis. Methods In a single-center study patients operated for colorectal cancer between 1989 and 2013 were identified from a prospectively maintained database. Median follow-up was 44 months. Patients with neoadjuvant treatment were excluded. The impact of urgent operation on overall and disease-free survival was assessed using both Cox regression and propensity score analyses. Results Of 747 patients with colorectal cancer, 84 (11 %) had urgent and 663 elective cancer resection. The propensity score revealed strongly biased patient characteristics (0.22 ± 0.16 vs. 0.10 ± 0.09; P < 0.001). In unadjusted analysis urgent operation was associated with a 35 % increased risk of overall mortality (hazard ratio(HR) of death = 1.35, 95 % confidence interval(CI):1.02–1.78, P = 0.045). In risk-adjusted Cox regression analysis urgent operation was not associated with poor overall (HR = 1.08, 95 %CI:0.79–1.48; P = 0.629) or disease-free survival (HR = 1.02, 95 %CI:0.76–1.38; P = 0.877). Similarly in propensity score analysis urgent operation did not influence overall (HR = 0.98, 95 % CI:0.74–1.29), P = 0.872) and disease-free survival (HR = 0.89, 95 %CI:0.68 to 1.16, P = 0.387). Conclusions This study provides evidence that worse oncologic outcomes after urgent operation for colorectal cancer are caused by clinical circumstances and not due to the urgent operation itself. Urgent operation is not a risk factor for colorectal cancer resection.
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Affiliation(s)
- Benjamin Weixler
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.,Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michaela Ramser
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Raoul Droeser
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Urs von Holzen
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Goshen Center for Cancer Care, Goshen, IN, 46507, USA
| | - Daniel Oertli
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Christoph Kettelhack
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Sucullu I, Ozdemir Y, Cuhadar M, Balta AZ, Yucel E, Filiz AI, Gulec B. Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: A retrospective study. Pak J Med Sci 2016; 31:1322-7. [PMID: 26870090 PMCID: PMC4744275 DOI: 10.12669/pjms.316.8277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Colon cancer patients presented with obstruction were known to have worse postoperative morbidity and mortality rates, but conflicting data has been reported in recent years. We aimed to investigate postoperative complication rates, and short and long-term oncological outcomes in patients with colon cancer treated with either emergency surgery due to obstruction or elective surgery. Methods: Two hundred fifty two patients were analyzed. Patients presented with obstruction and underwent an emergency surgery, and patients operated under elective circumstances were compared according to their demographic variables, tumor characteristics, and short and long term treatment outcomes. Results: Distribution of age, gender and comorbidities were similar between both the groups. Need for an end colostomy was significantly higher in obstructed patients (22.7% vs 1.6%, respectively). Obstructed patients were tending to be at an advanced stage. Postoperative morbidity and mortality, and prognosis of colon cancer patients presented with obstruction is worse than patients operated under elective circumstances. Conclusions: Colon cancer patients presented with obstruction constitutes more than one quarter of all patients. These patients have significantly higher morbidity and mortality rates. Obstructed colon cancer usually appears at advanced stage. Primary resection and anastomosis is safe in most of the cases.
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Affiliation(s)
- Ilker Sucullu
- Ilker Sucullu, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Yavuz Ozdemir
- Yavuz Ozdemir, Assistant Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Mehmet Cuhadar
- Mehmet Cuhadar, Resident Doctor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ahmet Ziya Balta
- Ahmet Ziya Balta, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ergun Yucel
- Ergun Yucel, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ali Ilker Filiz
- Ali Ilker Filiz, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Bulent Gulec
- Bulent Gulec, Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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Zhang JK, Fang LL, Zhang DW, Jin Q, Wu XM, Liu JC, Zhang CD, Dai DQ. Type D personality is associated with delaying patients to medical assessment and poor quality of life among rectal cancer survivors. Int J Colorectal Dis 2016; 31:75-85. [PMID: 26243469 DOI: 10.1007/s00384-015-2333-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this research was to explore quality of life (QoL), mental health status, type D personality, symptom duration, and emergency admissions of Chinese rectal cancer patients as well as the relationship between these factors. METHODS Type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QoL outcomes were assessed longitudinally using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. RESULTS Of the 852 survivors who responded (94 %), 187 (22 %) had a type D personality. The proportion of patients with duration of symptoms >1 month and being diagnosed after emergency admissions in type D group is significantly higher than that in non-type D group. At both of the time points, type D patients reported statistically significant lower scores on most of the functional scales, global health status/QoL scales, and worse symptom scores compared to patients without a type D personality. At the 6-month time point, a higher percentage of patients in the type D group demonstrated QoL deterioration. Clinically elevated levels of anxiety and depression were more prevalent in type D than in non-type D survivors. CONCLUSIONS Type D personality was associated with poor QoL and mental health status among survivors of rectal cancer, even after adjustment for confounding background variables. Type D personality might be a general vulnerability factor to screen for subgroups at risk for longer symptom duration and emergency admissions in clinical practice.
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Affiliation(s)
- Jia-kui Zhang
- Department of Gastroenterological Surgery and Cancer Center, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, P. R. China
| | - Li-li Fang
- Department of Anesthesiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - De-wei Zhang
- Department of Gastroenterological Surgery and Cancer Center, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, P. R. China
| | - Qiu Jin
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, People's Republic of China
| | - Xiao-mei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Ji-chao Liu
- Department of Gastroenterological Surgery and Cancer Center, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, P. R. China
| | - Chun-dong Zhang
- Department of Gastroenterological Surgery and Cancer Center, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, P. R. China
| | - Dong-qiu Dai
- Department of Gastroenterological Surgery and Cancer Center, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan Road, Shenyang, 110032, P. R. China.
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Catastrophic pneumoperitoneum in a patient with perforated colorectal cancer with liver metastasis. Am J Emerg Med 2015; 34:344.e3-5. [PMID: 26242812 DOI: 10.1016/j.ajem.2015.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 11/22/2022] Open
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Colorectal cancer with intestinal perforation - a retrospective analysis of treatment outcomes. Contemp Oncol (Pozn) 2014; 18:414-8. [PMID: 25784840 PMCID: PMC4355655 DOI: 10.5114/wo.2014.46362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 12/18/2022] Open
Abstract
Aim of the study Colorectal cancer (CRC) is one of the leading cause of death in European population. It progresses without any symptoms in the early stages or those clinical symptoms are very discrete. The aim of this study was a retrospective analysis of treatment outcomes in patients with colorectal cancer complicated with intestinal perforation. Material and methods A retrospective analysis of patients urgently operated upon in our Division of General Surgery, because of large intestine perforation, from February 1993 to February 2013 has been made. Results were compared with a group of patients undergoing the elective surgery for colorectal cancer in the same time and Division. Results Intestinal perforation occurred more often in males (6.52% vs. 6.03%), patients with mucous component in histopathological examination (9.09% vs. 6.01%) and with clinicaly advanced CRC. Patients treated because of perforation had a five-fold higher 30 day mortality rate (9.09% vs. 1.83%), however long-term survival did not differ significantly in both groups. After resectional surgery in 874 patients an intestinal anastomosis was made. Anastomotic leakage was present in 23 (2.6%) patients. This complication occurred six-fold more frequently in a group of patients operated upon because of intestinal perforation (12.20% vs. 2.16%). Conclusions In patients with CRC complicated with perforation of the colon in a 30-day observation significantly higher rate of complications and mortality was shown, whereas there was no difference in distant survival rates.
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Amri R, Bordeianou LG, Sylla P, Berger DL. Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 2014; 209:246-53. [PMID: 25457246 DOI: 10.1016/j.amjsurg.2014.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/27/2014] [Accepted: 07/03/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer. METHODS A retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed. RESULTS Emergency patients required longer surgeries (median 141 vs 124 minutes; P = .04), longer median admissions (8% vs 5%; P < .001), more readmissions (12.7% vs 7.1%; P = .040), and perioperative mortality (7.8% vs .8%; P < .001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P < .001), extramural vascular invasion (39.6% vs 29.1%; P = .021), and metastatic disease (19.6% vs 8%; P < .001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P = .003) and shorter disease-free survival (hazard ratio = 1.39; P = .042). CONCLUSIONS Emergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.
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Affiliation(s)
- Ramzi Amri
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Patricia Sylla
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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The evolution of surgery for the treatment of malignant large bowel obstruction. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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van Oudheusden TR, Braam HJ, Nienhuijs SW, Wiezer MJ, van Ramshorst B, Luyer MD, Lemmens VE, de Hingh IH. Cytoreduction and hyperthermic intraperitoneal chemotherapy: a feasible and effective option for colorectal cancer patients after emergency surgery in the presence of peritoneal carcinomatosis. Ann Surg Oncol 2014; 21:2621-6. [PMID: 24671638 DOI: 10.1245/s10434-014-3655-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND When peritoneal carcinomatosis (PC) is diagnosed during emergency surgery for colorectal cancer (CRC), further treatment with curative intent may seem futile given the known poor prognosis of both PC and emergency surgery. The aim of the current study was to investigate the feasibility and effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC patients who previously underwent emergency surgery in the presence of PC. METHODS All patients with synchronous PC of CRC referred to two tertiary centers between April 2005 and November 2013 were included in this study. Operative, postoperative and survival details were compared between patients presenting in an emergency or elective setting. RESULTS In total, 149 patients with synchronous PC underwent CRS and HIPEC. Amongst these patients, 36 (24.2 %) initially presented with acute symptoms requiring emergency surgery. Acute presentation did not result in a longer interval between the initial operation and HIPEC (2.2 vs. 2.1 months; P = 0.09). When comparing operative outcomes, no significant differences were found in blood loss (P = 0.47), operation time (P = 0.39), or completeness of cytoreduction (P = 0.97). In addition, complication rates, degree and types of complication did not differ between the groups. Median survival was 36.1 months for emergency presentation compared with 32.1 in the elective group (P = 0.73). CONCLUSION CRS + HIPEC may be performed safely in patients with PC of colorectal origin presenting with acute symptoms requiring emergency surgery. More importantly, the 5-year survival rate in these patients was equal to elective cases. This should be regarded as promising and therefore considered for these patients.
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Anantha RV, Brackstone M, Parry N, Leslie K. An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case-control study. World J Emerg Surg 2014; 9:19. [PMID: 24656174 PMCID: PMC3994420 DOI: 10.1186/1749-7922-9-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/18/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Emergency colorectal cancer (CRC) is a complex disease that requires multidisciplinary approaches for management. However, it is unclear whether acute care surgery (ACS) services can expedite the workup and treatment of complex surgical diseases such as emergency CRC. We sought to assess the impact of an Acute Care and Emergency Surgery Service (ACCESS) on wait-times for inpatient colonoscopy and surgical resection among emergency CRC patients. Methods This retrospective case–control study was conducted at a tertiary-care, university-affiliated, cancer centre in London, Ontario, Canada. All patients aged 18 or older who presented to the emergency department with a recent (within 48 hours) diagnosis of CRC, or were diagnosed with CRC after admission, were included in the study. Patients were either in the pre-ACCESS (July 1, 2007-June 31, 2010) or post-ACCESS (July 1, 2010-June 30, 2012) groups. A third group of emergency CRC patients treated at an adjacent cancer centre that lacked ACCESS (non-ACCESS) was evaluated separately. The primary outcome was time from admission to colonoscopy and surgery. Results A total of 149 patients (47 pre-ACCESS, 37 post-ACCESS, and 65 non-ACCESS) were identified. Only 19% (n = 9) of pre-ACCESS patients underwent inpatient colonoscopy, compared to 38% (n = 14) in the post-ACCESS group (p = 0.023). Additionally, 100% of patients in the post-ACCESS era underwent inpatient colonoscopy and surgery during the same admission, compared to only 44% of pre-ACCESS patients (p = 0.006). Median wait-times for inpatient colonoscopy (2.0 and 1.8 days for pre- and post-ACCESS groups respectively, p = 0.08) and surgical resection (1.6 and 2.3 days for pre- and post-ACCESS groups respectively, p = 0.40) were similar. Conclusions Patients admitted to ACCESS underwent more inpatient colonoscopies and were more likely to have definitive surgery on that admission. ACS services can facilitate the workup and management of complex surgical diseases such as emergency CRC without delaying treatment.
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Affiliation(s)
| | | | | | - Ken Leslie
- Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg 2013; 207:127-38. [PMID: 24124659 DOI: 10.1016/j.amjsurg.2013.07.027] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/11/2013] [Accepted: 07/18/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The management of colonic obstruction has changed in recent years. In distal obstruction, optimal treatment remains controversial, particularly after the appearance and use of colonic endoluminal stents. The purpose of this study was to review the current treatment of acute malignant large bowel obstruction according to the level of evidence of the available literature. METHODS A systematic search was conducted in PubMed, MEDLINE, Embase, and Google Scholar for articles published through January 2013 to identify studies of large bowel obstruction and colorectal cancer. Included studies were randomized and nonrandomized controlled trials, reviews, systematic reviews, and meta-analysis. RESULTS After a literature search of 1,768 titles and abstracts, 218 were selected for full-text assessment; 59 studies were ultimately included. Twenty-five studies of the diagnosis and treatment of obstruction and 34 studies of the use of stents were assessed. CONCLUSIONS In view of the various alternatives and the lack of high-grade evidence, the treatment of distal colonic obstruction should be individually tailored to each patient.
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Chalieopanyarwong V, Boonpipattanapong T, Prechawittayakul P, Sangkhathat S. Endoscopic obstruction is associated with higher risk of acute events requiring emergency operation in colorectal cancer patients. World J Emerg Surg 2013; 8:34. [PMID: 24010827 PMCID: PMC3846126 DOI: 10.1186/1749-7922-8-34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Unplanned emergency operations in colorectal cancers (CRC) are generally associated with increased risk of operative complications. This study aimed to examine the association, if any, between an endoscopic finding of obstructing tumor and the subsequent need for an emergency operation, with the aim of determining if this finding could be useful in identifying CRC cases who are more likely to require an emergency operation. METHODS The records of CRC cases operated on in our institute during the years 2002-2011 were retrospectively reviewed regarding an endoscopic obstruction (eOB), defined as a luminal obstruction of the colon or rectum severe enough to prevent the colonoscope from passing beyond the tumor. The eOBs were analyzed against outcomes in terms of need for emergency operation, surgical complications and overall survival (OS). RESULTS A total of 329 CRCs which had been operated on during the study period had complete colonoscopic data. eOB was diagnosed in 209 cases (64%). Occurrence of eOB was not correlated with clinical symptoms. Colon cancer had a higher incidence of eOB (70%) than rectal cases (50%) (p-value < 0.01). eOB was significantly associated with higher tumor size and more advanced T-stage (p < 0.01). Twenty-two cases (7%) had required an emergency operation before their scheduled elective surgery. The cases with eOB had a significantly higher risk of requiring an emergency operation while waiting for their scheduled procedure (p-value < 0.01), and these emergency surgeries had more post-operative complications (36%) than elective procedures (13%) (p-value 0.01) and poorer OS (p-value < 0.01). CONCLUSION Regardless of the presenting symptom, luminal obstruction severe enough to prevent further passage of a colonoscope should prompt the physician to consider an urgent surgery.
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Affiliation(s)
- Virote Chalieopanyarwong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Ghazi S, Berg E, Lindblom A, Lindforss U. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 2013; 11:133. [PMID: 23758762 PMCID: PMC3687686 DOI: 10.1186/1477-7819-11-133] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 05/09/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Studies report poorer outcome for patients who undergo emergency compared with elective surgery, both for their initial hospital stay and their long-term survival. Advanced tumor pathology and tumors with unfavorable histologic features may provide the basis for the difference in outcome. The aim of this study was to compare the clinical and pathologic profiles of emergency and elective surgical cases for colorectal cancer, and relate these to gender, age group, tumor location, and family history of the disease. The main outcome measure was the difference in morphology between elective and emergency surgical cases. METHODS In total, 976 tumors from patients treated surgically for colorectal cancer between 2004 and 2006 in Stockholm County, Sweden (8 hospitals) were analyzed in the study. Seventeen morphological features were examined and compared with type of operation (elective or emergency), gender, age, tumor location, and family history of colorectal cancer by re-evaluating the histopathologic features of the tumors. RESULTS In a univariate analysis, the following characteristics were found more frequently in emergency compared with elective cases: multiple tumors, higher American Joint Committee on Cancer (AJCC), tumor (T) and node (N) stage, peri-tumor lymphocytic reaction, high number of tumor-infiltrating lymphocytes, signet-ring cell mucinous carcinoma, desmoplastic stromal reaction, vascular and perineural invasion, and infiltrative tumor margin (P<0.0001 for AJCC stage III to IV, N stage 1 to 2/3, and vascular invasion). In a multivariate analysis, all these differences, with the exception of peri-tumor lymphocytic reaction, remained significant (P<0.0001 for multiple tumors, perineural invasion, infiltrative tumor margin, AJCC stage III, and N stage 1 to 2/3). CONCLUSIONS Colorectal cancers that need surgery as an emergency case generally show a more aggressive histopathologic profile and a more advanced stage than do elective cases. Essentially, no difference was seen in location, and therefore it is likely there would be no differences in macro-environment either. Our results could indicate that colorectal cancers needing emergency surgery belong to an inherently specific group with a different etiologic or genetic background.
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Affiliation(s)
- Sam Ghazi
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm S-14186, Sweden.
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Kim HJ, Huh JW, Kang WS, Kim CH, Lim SW, Joo YE, Kim HR, Kim YJ. Oncologic safety of stent as bridge to surgery compared to emergency radical surgery for left-sided colorectal cancer obstruction. Surg Endosc 2013; 27:3121-8. [DOI: 10.1007/s00464-013-2865-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/27/2013] [Indexed: 12/28/2022]
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Zielinski MD, Merchea A, Heller SF, You YN. Emergency management of perforated colon cancers: how aggressive should we be? J Gastrointest Surg 2011; 15:2232-8. [PMID: 21913040 DOI: 10.1007/s11605-011-1674-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/12/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making. STUDY DESIGN Patients with perforations associated with a primary colon cancer were identified. Peri-operative and long-term survival were compared among free (FP; n = 41) and contained perforations (CP; n = 45) and to age-, stage-, and resection status case-matched, non-perforated (NP; n = 85), controls. RESULTS Tumors were completely resected in 67% of FP but fewer lymph nodes were harvested (median, 11 vs. 11 and 16 in CP and NP; p = 0.21 and p < 0.001). Peri-operative mortality was highest in FP: 19% vs. 0% and 5% in CP and NP (p = 0.038), respectively. After adjusting for peri-operative mortality, 5-year overall survival was comparable: 55%, 59%, and 54% for FP, CP, and NP, respectively. Advanced age, higher ASA class, presence of residual disease, and advanced stage, but not perforation, were independent predictors of poorer long-term overall survival. CONCLUSIONS Patients with malignant colonic perforation face high risk of peri-operative death, making septic source control the priority in the acute setting. Pursuit of an oncologically oriented resection and long-term cancer-directed treatments, however, may lead to improved long-term outcomes.
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