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Yang FF, Serrano E, Bilodeau KS, Weykamp M, Silvestri CJ, Bull ACM, Lin B, Schaefer SL, Galet C, Garcia LJ, Gitonga B, Kolodziej DT, Esposito S, Parker-Brigham M, Luhar R, Mamgain A, Brown KC, Dewdney S, Price TP, Siparsky N, Knerr S, Park PK, Sanchez S, Skeete DA, Fischkoff KN, Flum DR. Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction. ANNALS OF SURGERY OPEN 2024; 5:e431. [PMID: 38911621 PMCID: PMC11191995 DOI: 10.1097/as9.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/09/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes. Background mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use. Methods This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression. Results Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%-30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%-20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%-21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4-1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3-1.1). Conclusion Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement.
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Affiliation(s)
- Frank F. Yang
- From the Department of Surgery, University of Washington, Seattle, WA
| | - Elina Serrano
- From the Department of Surgery, University of Washington, Seattle, WA
| | - Kyle S. Bilodeau
- From the Department of Surgery, University of Washington, Seattle, WA
| | - Michael Weykamp
- From the Department of Surgery, University of Washington, Seattle, WA
| | | | - Ashleigh C. M. Bull
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brenda Lin
- Department of Surgery, Boston University, Boston, MA
| | | | - Colette Galet
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Luis J. Garcia
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Baraka Gitonga
- From the Department of Surgery, University of Washington, Seattle, WA
| | - David T. Kolodziej
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - Rohan Luhar
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Avinash Mamgain
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | | | - Summer Dewdney
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Thea P. Price
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Nicole Siparsky
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Sarah Knerr
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Pauline K. Park
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Dionne A. Skeete
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - David R. Flum
- From the Department of Surgery, University of Washington, Seattle, WA
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Lilley EJ, Farber ON, Cooper Z. Palliative surgery: state of the science and future directions. Br J Surg 2024; 111:znae068. [PMID: 38502548 PMCID: PMC10949962 DOI: 10.1093/bjs/znae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/07/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Palliative surgical procedures are operations that aim to alleviate symptoms in a patient with serious, life-limiting illness. They are common, particularly within the field of surgical oncology. However, few high-quality studies have attempted to measure the durability of improvements in symptoms and quality of life after palliative surgery. Furthermore, many of the studies that do exist are outdated and employ highly inconsistent definitions of palliative surgery. Consequently, the paucity of robust and reliable evidence on the benefits, risks, and trade-offs of palliative surgery hampers clinical decision-making for patients and their surgeons. The evidence for palliative surgery suggests that, with effective communication about goals of care and careful patient selection, palliative surgery can provide symptomatic relief and reduce healthcare burdens for certain seriously ill patients.
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Affiliation(s)
- Elizabeth J Lilley
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Orly N Farber
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Zara Cooper
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Krouse RS, Anderson GL, Arnold KB, Thomson CA, Nfonsam VN, Al-Kasspooles MF, Walker JL, Sun V, Alvarez Secord A, Han ES, Leon-Takahashi AM, Isla-Ortiz D, Rodgers P, Hendren S, Sanchez Salcedo M, Laryea JA, Graybill WS, Flaherty DC, Mogal H, Miner TJ, Pimiento JM, Kitano M, Badgwell B, Whalen G, Lamont JP, Guevara OA, Senthil MS, Dewdney SB, Silberfein E, Wright JD, Friday B, Fahy B, Anantha Sathyanarayana S, O'Rourke M, Bakitas M, Sloan J, Grant M, Deutsch GB, Deneve JL. Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial. Lancet Gastroenterol Hepatol 2023; 8:908-918. [PMID: 37541263 PMCID: PMC10530384 DOI: 10.1016/s2468-1253(23)00191-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Malignant small bowel obstruction has a poor prognosis and is associated with multiple related symptoms. The optimal treatment approach is often unclear. We aimed to compare surgical versus non-surgical management with the aim to determine the optimal approach for managing malignant bowel obstruction. METHODS S1316 was a pragmatic comparative effectiveness trial done within the National Cancer Trials Network at 30 hospital and cancer research centres in the USA, Mexico, Peru, and Colombia. Participants had an intra-abdominal or retroperitoneal primary cancer confirmed via pathological report and malignant bowel disease; were aged 18 years or older with a Zubrod performance status 0-2 within 1 week before admission; had a surgical indication; and treatment equipoise. Participants were randomly assigned (1:1) to surgical or non-surgical treatment using a dynamic balancing algorithm, balancing on primary tumour type. Patients who declined consent for random assignment were offered a prospective observational patient choice pathway. The primary outcome was the number of days alive and out of the hospital (good days) at 91 days. Analyses were based on intention-to-treat linear, logistic, and Cox regression models combining data from both pathways and adjusting for potential confounders. Treatment complications were assessed in all analysed patients in the study. This completed study is registered with ClinicalTrials.gov, NCT02270450. FINDINGS From May 11, 2015, to April 27, 2020, 221 patients were enrolled (143 [65%] were female and 78 [35%] were male). There were 199 evaluable participants: 49 in the randomised pathway (24 surgery and 25 non-surgery) and 150 in the patient choice pathway (58 surgery and 92 non-surgery). No difference was seen between surgery and non-surgery for the primary outcome of good days: mean 42·6 days (SD 32·2) in the randomised surgery group, 43·9 days (29·5) in the randomised non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group (adjusted mean difference 2·9 additional good days in surgical versus non-surgical treatment [95% CI -5·5 to 11·3]; p=0·50). During their initial hospital stay, six participants died, five due to cancer progression (four patients from the randomised pathway, two in each treatment group, and one from the patient choice pathway, in the surgery group) and one due to malignant bowel obstruction treatment complications (patient choice pathway, non-surgery). The most common grade 3-4 malignant bowel obstruction treatment complication was anaemia (three [6%] patients in the randomised pathway, all in the surgical group, and five [3%] patients in the patient choice pathway, four in the surgical group and one in the non-surgical group). INTERPRETATION In our study, whether patients received a surgical or non-surgical treatment approach did not influence good days during the first 91 days after registration. These findings should inform treatment decisions for patients hospitalised with malignant bowel obstruction. FUNDING Agency for Healthcare Research and Quality and the National Cancer Institute. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Robert S Krouse
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Garnet L Anderson
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kathryn B Arnold
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Valentine N Nfonsam
- Department of Surgery, University of Arizona, Tucson, AZ, USA; Department of Surgery, Louisiana State University, New Orleans, LA, USA
| | | | - Joan L Walker
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Virginia Sun
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA
| | - Angeles Alvarez Secord
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC, USA
| | - Ernest S Han
- Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - David Isla-Ortiz
- Department of Surgical Oncology, National Cancer Institute, Tlalpan, Mexico City, Mexico
| | - Phillip Rodgers
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Samantha Hendren
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marco Sanchez Salcedo
- Department of Surgery, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru
| | - Jonathan A Laryea
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Whitney S Graybill
- Department of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Devin C Flaherty
- Department of Surgical Oncology, Valley Health, Winchester, VA, USA
| | - Harveshp Mogal
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; University of Washington, Seattle, WA, USA
| | - Thomas J Miner
- Department of Surgery, Rhode Island Hospital, Providence, RI, USA
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Mio Kitano
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Brian Badgwell
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Giles Whalen
- Department of Surgical Oncology, Umass Memorial Medical Center, Worcester, MA, USA
| | - Jeffrey P Lamont
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Oscar A Guevara
- Division of Gastrointestinal Surgery, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Maheswari S Senthil
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA; University of California-Irvine, Orange, CA, USA
| | - Summer B Dewdney
- Department of Obstetrics and Gynecology Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Eric Silberfein
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Columbia University Medical Center, New York, NY, USA
| | - Bret Friday
- Department of Hematology/Oncology Essentia Health Cancer Center, Duluth, MN, USA
| | - Bridget Fahy
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | | | - Mark O'Rourke
- Center for Integrative Oncology and Survivorship, Greenville Health System, Clemson, SC, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff Sloan
- Mayo Clinic Rochester, Rochester, MN, USA
| | - Marcia Grant
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA
| | - Gary B Deutsch
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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4
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Ayabe RI, Mendoza T, Yennu S, Bruera E, Williams LA, Badgwell B. Symptom Burden in Patients with Malignant Bowel Obstruction Treated With or Without Surgery. J Am Coll Surg 2023; 236:514-522. [PMID: 36729796 DOI: 10.1097/xcs.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastrointestinal obstruction is the most common indication for palliative surgical consultation. We sought to assess patient-reported outcomes and survival after surgical and nonsurgical treatment of malignant bowel obstruction. STUDY DESIGN This was a prospective observational study enrolling patients with advanced malignancy who underwent surgical consultation at a tertiary cancer center. Patient-reported outcomes were evaluated using a previously validated inventory, the MD Anderson Symptom Inventory-Gastrointestinal Obstruction (MDASI-GIO), administered at enrollment and 7 other time points for up to 90 days. RESULTS We enrolled 125 patients, of whom 37 underwent surgery and 88 did not. Patients treated nonsurgically were more likely to have carcinomatosis on imaging (71% vs 49%, p = 0.02). Pain medicine, palliative care, and chaplaincy consultations occurred in 17%, 30%, and 15% of patients within the first month of enrollment. Higher mean symptom scores were noted by surgical patients, although the only single scores with effect sizes 0.5 or greater were symptom interference with general activity and work. The composite score for interference in work, activity, and walking had the largest effect size at -0.37, indicating greater interference in patients undergoing surgery. Patients selected for surgery had extended overall survival (median 15 vs 3 months, p < 0.01). Carcinomatosis, palliative care evaluation, and venting gastrostomy tube were associated with increased risk of death, and ability to receive subsequent chemotherapy and surgical management were positive prognostic indicators. CONCLUSIONS In this first study evaluating patient-reported outcomes after treatment for malignant bowel obstruction, we found that selection for surgical treatment was associated with improved survival, but also more symptom interference in general activities and work. These results may be useful in palliative surgical decision-making and informing patients during consultation for malignant bowel obstruction.
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Affiliation(s)
- Reed I Ayabe
- From the Departments of Surgical Oncology (Ayabe, Badgwell), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito Mendoza
- Symptom Research (Mendoza, Williams), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sriram Yennu
- Palliative Care Medicine (Yennu, Bruera), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Palliative Care Medicine (Yennu, Bruera), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta A Williams
- Symptom Research (Mendoza, Williams), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Badgwell
- From the Departments of Surgical Oncology (Ayabe, Badgwell), University of Texas MD Anderson Cancer Center, Houston, TX
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5
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Razak O A, Yang SY, Cho MS, Min BS, Han YD. Palliative surgery as a bridge to systemic treatment for malignant bowel obstruction due to peritoneal metastases: A retrospective, case-control study. Asian J Surg 2023; 46:160-165. [PMID: 35260331 DOI: 10.1016/j.asjsur.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High-quality data on palliative surgery in patients with malignant bowel obstruction (MBO) caused by peritoneal metastases (PM) are lacking. We aimed to determine the utility of palliative surgery for such patients. METHODS We retrospectively analyzed patients considered for surgery for MBO, caused by PM, in our department from January 2019 to October 2020. None of them could tolerate a diet, despite conservative treatment. We investigated the clinical characteristics and perioperative outcomes and calculated overall survival (OS). Kaplan-Meier survival analysis was performed, with the log-rank test to evaluate differences in OS rates. Multivariate Cox regression was performed to determine prognostic factors. RESULTS Sixty (67%) patients underwent surgery, whereas, 30 (33%) received the best supportive care (BSC) treatment. A better (p = 0.002) median OS was observed in patients undergoing surgery (3.9 months) than in those receiving BSC (2.6 months). Severe complications were observed in 12 (20%) patients, including 30-day mortality (7 patients). Forty-eight (80%) patients in the surgery group could tolerate a diet and the hospital stay (mean ± standard deviation) was 20.0 ± 23.1 days. Re-obstruction was observed in five (8.3%) patients after 78.6 ± 63.3 days. Patients in the postoperative chemotherapy group exhibited a better (p < 0.001) median OS (12.3 months) than did those in the no-postoperative chemotherapy group (3.5 months). Only postoperative chemotherapy (hazard ratio 0.264, 95% confidence interval 0.143-0.487, p < 0.001) was identified as an independent prognostic factor. CONCLUSIONS Compared with BSC, surgery is associated with a better OS in patients with MBO due to PM. Surgery should be considered as a bridge to systemic treatment for such patients.
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Affiliation(s)
| | - Seung Yoon Yang
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Wong JSM, Ng IAT, Juan WKD, Ong WS, Yang GM, Finkelstein EA, Gandhi M, Ong CAJ, Seo CJ, Zhu HY, Chia CS. Trajectories of Patient-Reported Outcomes After Palliative Gastrointestinal Surgery in Advanced Cancer: Is Good Quality of Life Sustainable? ANNALS OF SURGERY OPEN 2022; 3:e206. [PMID: 37600285 PMCID: PMC10406115 DOI: 10.1097/as9.0000000000000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
To evaluate the trajectories and sustainability of health-related quality of life (HRQoL) outcomes after palliative gastrointestinal (GI) surgery and perioperative factors associated with HRQoL improvement postsurgery. Background Palliative patients face a wide range of physical, emotional, social, and functional challenges. In evaluating the efficacy of palliative surgical interventions, a major pitfall of traditional surgical outcome measures is that they fall short of measuring outcomes that are meaningful to patients during end-of-life. HRQoL tools may provide a more comprehensive assessment of the true value and impact of palliative surgery. Methods We prospectively recruit advanced cancer patients undergoing palliative GI surgery. The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was administered before and at regular intervals after surgery. HRQoL improvement was defined as ≥4-points increment in FACT-G total score over baseline. Duration of sustained HRQoL improvement above this threshold and factors associated with varying extents of HRQoL change were evaluated. Results Of the 65 patients, intestinal obstruction was the most common indication for surgery (70.8%). The mean baseline FACT-G total score was 70.7 (95% CI: 66.3-75.1). Forty-six (70.8%) patients experienced HRQoL improvement after surgery. This HRQoL improvement was sustained over a median duration of 3.5 months and was driven mainly by improvements in patients' physical and emotional well-being. Albumin was significantly associated with the extent of HRQoL improvements (P = 0.043). Conclusion A clinically significant and sustained improvement in HRQoL was observed after palliative GI surgery. Patients with higher preoperative albumin levels were more likely to experience HRQoL improvements.
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Affiliation(s)
- Jolene S. M. Wong
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Irene A. T. Ng
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Wen Kai D. Juan
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Grace M. Yang
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | | | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Chin-Ann J. Ong
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore
| | - Chin Jin Seo
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Hong-Yuan Zhu
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Claramae S. Chia
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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7
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Tan WS, Ta A, Kelly JD. Robotic surgery: getting the evidence right. Med J Aust 2022; 217:391-393. [PMID: 36183333 PMCID: PMC9828009 DOI: 10.5694/mja2.51726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Wei Shen Tan
- University College London Hospitals NHS Foundation TrustLondonUK,Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Anthony Ta
- University College London Hospitals NHS Foundation TrustLondonUK
| | - John D Kelly
- University College London Hospitals NHS Foundation TrustLondonUK,Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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8
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Bleicher J, Lambert LA, Scaife CL, Colonna A. Current management of malignant bowel obstructions: a survey of acute care surgeons and surgical oncologists. Trauma Surg Acute Care Open 2021; 6:e000755. [PMID: 34222676 PMCID: PMC8211049 DOI: 10.1136/tsaco-2021-000755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Malignant small bowel obstructions (MSBOs) are one of the most challenging problems surgeons encounter, and evidence-based treatment recommendations are lacking. We hypothesized that current opinions on MSBO management differ between acute care surgeons (ACSs) and surgical oncologists (SOs). Methods We developed three case scenarios describing patients with previously treated cancer who developed an MSBO. Each case had five to six alternate scenarios, intended to capture the heterogeneity of MSBO presentations. Members of the Society of Surgical Oncology, the American Society of Peritoneal Surface Malignancies, and the Eastern Association for the Surgery of Trauma were asked how likely they would be to offer surgical treatment in each scenario. Responses were analyzed for factors associated with the likelihood surgeons would offer surgical management. Results 316 surgeons completed the survey: 119 (37.7%) SOs and 197 (62.3%) ACSs. Overall, SOs were nearly twice as likely as ACSs to recommend surgical management. The largest differences between provider groups were seen in patients with an increased metastatic burden. In a patient with MSBO with metastatic colon cancer, both SOs (95.8%) and ACSs (94.4%) were likely or very likely to offer an operation (p=0.587); however, this fell to 91.6% and 77.7%, respectively, when this patient had multiple hepatic metastases (p=0.001). All surgeons were less likely to offer surgery to patients with multiple sites of obstruction, recurrent MSBO, and shorter disease-free intervals. Discussion Opinions on MSBO management differ based on surgeon training and experience. Multidisciplinary management of patients with MSBO should be offered when available and increased emphasis placed on determining optimal management guidelines across specialties. Level of evidence Level IV Epidemiologic.
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Affiliation(s)
- Josh Bleicher
- General Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Laura A Lambert
- General Surgery, University of Utah Health, Salt Lake City, Utah, USA.,Surgical Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Courtney L Scaife
- General Surgery, University of Utah Health, Salt Lake City, Utah, USA.,Surgical Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Alexander Colonna
- General Surgery, University of Utah Health, Salt Lake City, Utah, USA
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