1
|
Rotellini-Coltvet L, Wallace A, Saini G, Naidu S, Kriegshauser JS, Patel I, Knuttinen G, Alzubaidi S, Oklu R. Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes. J Vasc Interv Radiol 2023; 34:1901-1907. [PMID: 37419279 DOI: 10.1016/j.jvir.2023.06.040] [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] [Received: 01/27/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
PURPOSE To demonstrate the safety and effectiveness of percutaneous transesophageal gastrostomy (PTEG) as a palliative option in patients with malignant bowel obstructions (MBOs), and provide a comprehensive review of PTEG indications, placement technique, and short- and long-term outcomes. MATERIALS AND METHODS Thirty-eight consecutive patients who underwent a PTEG procedure attempt from 2014 to 2022 were included in this analysis. Clinical indications, method of placement, technical and clinical success, adverse events, including procedure-related mortality, and effectiveness were assessed. Technical success was defined as placement of a PTEG. Clinical success was defined as improvement in clinical symptoms following PTEG placement. RESULTS Of the 38 patients who underwent PTEG, 19 (50%) were men and 19 (50%) were women (median age, 58 years; range, 21-75 years). Three (8%) PTEG placements were performed with the patients under moderate sedation, whereas the remainder (92%) were performed with the patients under general anesthesia. Technical success was achieved in 35 of the 38 (92%) patients. The mean catheter duration was 61 days (median, 29 days; range, 1-562 days), with 5 of the 35 patients requiring tube exchanges after initial placement. Moreover, 7 of the 35 patients with successful PTEG placement experienced an adverse event, including 1 case of non-procedure-related mortality. All patients with successful PTEG placement experienced improvement in clinical symptoms. CONCLUSIONS PTEG is an effective and safe option for patients with contraindications to traditional percutaneous gastrostomy tube placement in the setting of MBO. PTEG is an effective means of providing palliation and improving the quality of life.
Collapse
Affiliation(s)
- Lisa Rotellini-Coltvet
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona.
| | - Alex Wallace
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | - Gia Saini
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | | | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | - Grace Knuttinen
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital Arizona, Phoenix, Arizona
| |
Collapse
|
2
|
Nagashima Y, Funahashi K, Kagami S, Ushigome M, Kaneko T, Miura Y, Yoshida K, Koda T, Kurihara A. Which preoperative immunonutritional index best predicts postoperative mortality after palliative surgery for malignant bowel obstruction in patients with late-stage cancer? A single-center study in Japan comparing the modified Glasgow prognostic score (mGPS), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT). Surg Today 2023; 53:22-30. [PMID: 35781553 DOI: 10.1007/s00595-022-02534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/24/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To compare the utility of preoperative immunonutritional parameter measures for predicting postoperative mortality following palliative surgery (PS) for malignant bowel obstruction (MBO) in patients with late-stage cancer. METHODS The subjects of this retrospective study were 83 late-stage cancer patients with MBO who underwent PS between January, 2005 and December, 2018, at a single institution in Japan. We compared the modified Glasgow prognostic score (mGPS), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT) for predicting postoperative mortality following PS in these patients. RESULTS The most prevalent cancer in the patients who underwent PS was colorectal cancer (54.2%), followed by gastric cancer (24.1%). Postoperative complications of Clavien-Dindo classification grade ≥ 2 developed in 32 (38.6%) patients and stoma-related complications developed in 26 (31.3%) patients. There were 15 (18.1%) patients with 60-day mortality, 22 (26.5%) with 90-day mortality, and 4 (4.8%) with 30-day mortality. Multivariable analysis identified only mGPS as being associated with 60-day mortality (odds ratio, 9.387; 95% confidence interval, 0.001-4.478; p = 0.049). The overall survival of patients with a mGPS score of 2 was significantly worse than that of those with a mGPS score of < 2 (p = 0.013). CONCLUSIONS These results suggest that the mGPS is a good predictor not only of 60-day mortality, but also of the overall survival of patients with late-stage cancer and MBO.
Collapse
Affiliation(s)
- Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan.
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Mitsunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Yasuyuki Miura
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Kimihiko Yoshida
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Takamaru Koda
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| |
Collapse
|
3
|
Gonzalez-Ochoa E, Alqaisi HA, Bhat G, Jivraj N, Lheureux S. Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges. Int J Womens Health 2022; 14:1849-1862. [PMID: 36597479 PMCID: PMC9805709 DOI: 10.2147/ijwh.s366680] [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: 09/17/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022] Open
Abstract
Malignant bowel obstruction (MBO) is one of the most severe complications in patients with advanced ovarian cancer, with an estimated incidence up to 50%. Its presence is related to poor prognosis and a life expectancy measured in weeks for inoperable cases. Symptoms are usually difficult to manage and often require hospitalization, which carries a high burden on patients, caregivers and the healthcare system. Management is complex and requires a multidisciplinary approach to improve clinical outcomes. Patients with inoperable MBO are treated medically with analgesics, antiemetics, steroids and antisecretory agents. Parenteral nutrition and gut decompression with nasogastric tube, venting gastrostomy or stenting may be used as supportive therapy. Treatment decision-making is challenging and often based on clinical expertise and local policies, with lack of high-quality evidence to optimally standardize management. The present review summarizes current literature on inoperable bowel obstruction in ovarian cancer, focusing on epidemiology, prognostic factors, clinical outcomes, medical management, multidisciplinary interventions and quality of life.
Collapse
Affiliation(s)
- Eduardo Gonzalez-Ochoa
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Husam A Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gita Bhat
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nazlin Jivraj
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence: Stephanie Lheureux, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada, Tel +1 416-946-2818, Email
| |
Collapse
|
4
|
Bravington A, Obita G, Baddeley E, Johnson MJ, Murtagh FE, Currow DC, Boland EG, Nelson A, Seddon K, Oliver A, Noble SI, Boland JW. The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review. Palliat Med 2022; 36:1336-1350. [PMID: 36131489 PMCID: PMC10150264 DOI: 10.1177/02692163221122352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malignant bowel obstruction, a complication of certain advanced cancers, causes severe symptoms which profoundly affect quality of life. Clinical management remains complex, and outcome assessment is inconsistent. AIM To identify outcomes evaluating palliative treatment for inoperable malignant bowel obstruction, as part of a four-phase study developing a core outcome set. DESIGN The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); PROSPERO (ID: CRD42019150648). Eligible studies included at least one subgroup with obstruction below the ligament of Treitz undergoing palliative treatment for inoperable malignant bowel obstruction. Study quality was not assessed because the review does not evaluate efficacy. DATA SOURCES Medline, Embase, the Cochrane Database, CINAHL, PSYCinfo Caresearch, Open Grey and BASE were searched for trials and observational studies in October 2021. RESULTS A total of 4769 studies were screened, 290 full texts retrieved and 80 (13,898 participants) included in a narrative synthesis; 343 outcomes were extracted verbatim and pooled into 90 unique terms across six domains: physiological, nutrition, life impact, resource use, mortality and survival. Prevalent outcomes included adverse events (78% of studies), survival (54%), symptom control (39%) and mortality (31%). Key individual symptoms assessed were vomiting (41% of studies), nausea (34%) and pain (33%); 19% of studies assessed quality of life. CONCLUSIONS Assessment focuses on survival, complications and overall symptom control. There is a need for definitions of treatment 'success' that are meaningful to patients, a more consistent approach to symptom assessment, and greater consideration of how to measure wellbeing in this population.
Collapse
Affiliation(s)
- Alison Bravington
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | | | - Elin Baddeley
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | | | - Elaine G Boland
- Queen's Centre for Oncology and Haematology, Cottingham, Hull, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Alfred Oliver
- National Cancer Research Institute, Consumer Liaison Group, Trans-Humber Consumer Research Panel, London, UK
| | - Simon Ir Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| |
Collapse
|
5
|
Zanatto RM, Lisboa CN, de Oliveira JC, dos Reis TCDS, Cabral Ferreira de Oliveira A, Coelho MJP, Vidigal BDÁ, Ribeiro HSDC, Ribeiro R, Fernandes PHDS, Braun AC, Pinheiro RN, Oliveira AF, Laporte GA. Brazilian Society of Surgical Oncology guidelines for malignant bowel obstruction management. J Surg Oncol 2022; 126:48-56. [DOI: 10.1002/jso.26930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | - Claudia Naylor Lisboa
- Instituto Nacional de Cancer José Alencar Gomes da Silva—INCA Rio de Janeiro RJ Brazil
| | | | | | | | - Manoel J. P. Coelho
- Departament of Surgical Oncology Hospital Santo Alberto Manaus Amazonas Brazil
| | | | | | - Reitan Ribeiro
- Department of Surgical Oncology Erasto Gaertner Hospital Curitiba Brazil
| | | | | | | | - Alexandre F. Oliveira
- Department of Surgical Oncology Juiz de Fora Federal University Juiz de Fora Minas Gerais Brazil
| | - Gustavo A. Laporte
- Department of Surgical Oncology Santa Casa de Porto Alegre/Santa Rita Hospital/Universidade Federal de Ciências da Saúde de Porto Alegre Porto Alegre Brazil
| |
Collapse
|