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Tradounsky GE. Gastro-Intestinal Symptoms in Palliative Care Patients. Curr Oncol 2024; 31:2341-2352. [PMID: 38668077 PMCID: PMC11049445 DOI: 10.3390/curroncol31040174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients' quality of life (QOL) and should be treated as quickly and aggressively as possible.
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Affiliation(s)
- Golda Elisa Tradounsky
- Palliative Care Services, Mount Sinai Hospital, CIUSSS West Central of the Island of Montreal, 5690 Cavendish Blvd, Côte Saint-Luc, QC H4W 1S7, Canada;
- Department of Family Medicine, McGill University, Montréal, QC H3S 1Z1, Canada
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Pavlidis ET, Galanis IN, Pavlidis TE. Management of obstructed colorectal carcinoma in an emergency setting: An update. World J Gastrointest Oncol 2024; 16:598-613. [PMID: 38577464 PMCID: PMC10989363 DOI: 10.4251/wjgo.v16.i3.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced (stage II, III or even IV). Diagnosis is based on clinical presentation, plain abdominal radiogram, computed tomography (CT), CT colonography and positron emission tomography/CT. The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes remains unknown. For the most common left-sided obstruction, the first choice should be either emergency surgery or endoscopic decompression by self-expendable metal stents or tubes. The operative plan should be either one-stage or two-stage resection. One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma (colostomy or ileostomy). Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity. Two-stage resection (Hartmann's procedure) is safer and the most widely used despite temporally affecting quality of life. Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing. For the less common right-sided obstruction, one-stage surgical resection is more beneficial than endoscopic decompression. The role of minimally invasive surgery (laparoscopic or robotic) is a subject of debate. Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rupture and subsequent septic complications. The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates. Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes. Management plans are crucial and must be individualized to better fit each case.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioannis N Galanis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Zattoni D, Montroni I, Saur NM, Garutti A, Bacchi Reggiani ML, Ghignone F, Taffurelli G, Ugolini G. Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool. World J Emerg Surg 2021; 16:12. [PMID: 33736667 PMCID: PMC7977323 DOI: 10.1186/s13017-021-00356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background Senior adults fear postoperative loss of independence the most, and this might represent an additional burden for families and society. The number of geriatric patients admitted to the emergency room requiring an urgent surgical treatment is rising, and the presence of frailty is the main risk factor for postoperative morbidity and functional decline. Frailty assessment in the busy emergency setting is challenging. The aim of this study is to verify the effectiveness of a very simple five-item frailty screening tool, the Flemish version of the Triage Risk Screening Tool (fTRST), in predicting functional loss after emergency surgery among senior adults who were found to be independent before surgery. Methods All consecutive individuals aged 70 years and older who were independent (activity of daily living (ADL) score ≥5) and were admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 were prospectively included in the study. On admission, individuals were screened using the fTRST and additional metrics such as the age-adjusted Charlson Comorbidity Index (CACI) and the ASA score. Thirty- and 90-day complications and postoperative decline in the ADL score where recorded. Regression analysis was performed to identify preoperative predictors of functional loss. Results Seventy-eight patients entered the study. Thirty-day mortality rate was 12.8% (10/78), and the 90-day overall mortality was 15.4% (12/78). One in every four patients (17/68) experienced a significant functional loss at 30-day follow-up. At 90-day follow-up, only 3/17 patients recovered, 2 patients died, and 12 remained permanently dependent. On the regression analysis, a statistically significant correlation with functional loss was found for fTRST, CACI, and age≥85 years old both at 30 and 90 days after surgery. fTRST≥2 showed the highest effectiveness in predicting functional loss at 90 days with AUC 72 and OR 6.93 (95% CI 1.71–28.05). The institutionalization rate with the need to discharge patients to a healthcare facility was 7.6% (5/66); all of them had a fTRST≥2. Conclusion fTRST is an easy and effective tool to predict the risk of a postoperative functional decline and nursing home admission in the emergency setting.
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Affiliation(s)
- Davide Zattoni
- Department of General Surgery, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy. .,Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy.
| | - Isacco Montroni
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Nicole Marie Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, 800 Walnut Street 20th floor, Philadelphia, PA, USA
| | - Anna Garutti
- Department of Geriatrics, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy
| | | | - Federico Ghignone
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Giovanni Taffurelli
- Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
| | - Giampaolo Ugolini
- Department of General Surgery, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy.,Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy
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Ren X, Chen B, Hong Y, Liu W, Jiang Q, Yang J, Qian Q, Jiang C. The challenges in colorectal cancer management during COVID-19 epidemic. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:498. [PMID: 32395542 PMCID: PMC7210180 DOI: 10.21037/atm.2020.03.158] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It has been over 2 months since the start of the Coronavirus disease 2019 (COVID-19) outbreak. The epidemic stage of COVID-19 has brought great challenges to the diagnosis and management of colorectal cancer (CRC) patients. Symptoms, such as fever and cough caused by cancer, and the therapeutic process (including chemotherapy and surgery) should be differentiated from some COVID-19 related characteristics. Besides, clinical workers should not only consider the therapeutic strategy for cancer, but also emphasize COVID-19's prevention. Moreover, the detailed therapeutic regimens of CRC patients may be different from the usual. Also, treatment principles may various for CRC patients with or without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as patients with or without an emergency presentation. In this paper, we want to discuss the above-mentioned problems based on previous guidelines, the current working status and our experiences, to provide a reference for medical personnel.
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Affiliation(s)
- Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Baoxiang Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Yuntian Hong
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Weicheng Liu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Qi Jiang
- Department of Pathology and Pathophysiology, Hubei Provincial Key Laboratory of Developmentally Originated Disease, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Jingying Yang
- Department of Anesthesia Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
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