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Jimba M, Enomoto T, Saida Y. Four Cases of Proximal Release-Type Colon Stents for Obstructive Rectal Cancer. Cureus 2024; 16:e59362. [PMID: 38694633 PMCID: PMC11061818 DOI: 10.7759/cureus.59362] [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: 04/29/2024] [Indexed: 05/04/2024] Open
Abstract
Malignant colonic obstruction can cause necrosis, bacterial translocation, electrolytic imbalance, and death; therefore, immediate decompression should be performed. Self-expandable metallic colonic stents are an established treatment for the decompression of malignant colonic obstructions. The use of stents that open from the distal side, which have been commonly used until now, requires caution because placing a stent on the dentate line can cause severe pain, and there is a possibility of cutting the stent during rectal resection of the distal side of the tumor. Therefore, we designed a new proximal-release-type colorectal stent for use in our hospital; it is 22 mm in diameter and 70 mm in length, which was placed using the over-the-wire method with a 16 Fr delivery system. We have encountered four cases in which it was appropriate as a bridge to surgical treatment. None of the patients experienced complications, such as bleeding, pain, or other incidents, after stent placement. Additionally, the stents were not affected by the surgical dissection of the rectum on the anorectal side of the tumor. Herein, we presented the four aforementioned cases and discussed the stenting techniques.
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Affiliation(s)
- Marina Jimba
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Toshiyuki Enomoto
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, JPN
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Kanaka S, Matsuda A, Yamada T, Yokoyama Y, Matsumoto S, Takahashi G, Sonoda H, Ohta R, Uehara K, Shinji S, Iwai T, Takeda K, Sekiguchi K, Kuriyama S, Miyasaka T, Yoshida H. Oncologic investigation of the interval from stent placement to surgery in patients with obstructive colorectal cancer. Surg Today 2024:10.1007/s00595-024-02818-w. [PMID: 38526561 DOI: 10.1007/s00595-024-02818-w] [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: 07/28/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Self-expandable metallic stent (SEMS) placement is widely used as a bridge to surgery (BTS) procedure for obstructive colorectal cancer. However, evidence regarding the optimal interval between SEMS placement and elective surgery is lacking. METHODS We retrospectively collected data from patients with BTS between January 2013 and October 2021. Inverse probability treatment-weighted propensity score analyses were used to compare short- and long-term outcomes between the short-interval (SI) and long-interval (LI) groups, using a cutoff of 20 days. RESULTS In total, 138 patients were enrolled in this study (SI group, n = 63; LI group, n = 75). In the matched cohort, the patients' backgrounds were well balanced. The incidence of Clavien-Dindo grade ≥ II postoperative complications was not significantly different between the SI and LI groups (19.0% vs. 14.0%, P = 0.47). There were no significant differences between the SI and LI groups in the 3-year recurrence-free survival (68.0% vs. 76.4%, P = 0.73) or 3-year overall survival rates (86.0% vs. 90.6%, P = 0.72). CONCLUSIONS A longer interval did not deteriorate the oncological outcomes. Individual perioperative management with an appropriate interval to improve the patient's condition is required to ensure safe surgery.
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Affiliation(s)
- Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Ryo Ohta
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kay Uehara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kohki Takeda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kumiko Sekiguchi
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Nambara S, Nakanishi R, Nonaka K, Fujimoto Y, Hu Q, Nakanoko T, Sugiyama M, Ota M, Kimura Y, Oki E, Toh Y, Yoshizumi T. A Multicenter Analysis of Short-term and Long-term Outcomes Following Laparoscopic Multivisceral Resection for Advanced Colorectal Cancer. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:157-164. [PMID: 38434926 PMCID: PMC10905295 DOI: 10.21873/cdp.10302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024]
Abstract
Background/Aim Recent research has demonstrated that laparoscopic multivisceral resection (MVR) for advanced colorectal cancer is safe, practicable, and yields satisfactory oncological results, which is in line with the growing usage of laparoscopic surgery. The effectiveness of laparoscopic MVR is still debatable, though. The goal of this study was to compare the short- and long-term results of patients with advanced colorectal cancer treated with open MVR with laparoscopic procedures. Patients and Methods Data on 3,571 consecutive patients hospitalized at the Kyushu University National Kyushu Cancer Center for colorectal cancer surgery between 2004 and 2020 were gathered retrospectively. In the end, 84 individuals with advanced colorectal cancer who had a colectomy with MVR were examined. We evaluated invasiveness in terms of complications, blood loss, and operating time. Recurrence-free survival rates and overall 5-year survival were among the oncological outcomes. Results Of the 84 patients examined, 29 underwent laparoscopic treatment, and 55 underwent open treatment. The laparoscopic surgery group experienced shorter hospital stays (15 vs. 18 days, p<0.05) and much less blood loss (median volume: 167 vs. 1,058 g, p<0.005) than the open surgery group. Following the exclusion of patients with stage IV colorectal cancer from the study (groups undergoing laparoscopic surgery, n=25; open surgery, n=38), the groups displayed comparable pathologic results and no discernible variations in either the 5-year overall survival (p=0.87) or recurrence-free survival (p=0.86). Conclusion In certain individuals with advanced colorectal cancer, a laparoscopic method of manipulation with MVR may be less invasive than an open method without compromising the prognosis.
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Affiliation(s)
- Sho Nambara
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kentaro Nonaka
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yoshiaki Fujimoto
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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Takahashi G, Matsuda A, Yamada T, Uehara K, Shinji S, Yokoyama Y, Iwai T, Takeda K, Kuriyama S, Miyasaka T, Kanaka S, Terayachi T, Okino T, Yoshida H. Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report. Surg Case Rep 2023; 9:201. [PMID: 37985577 PMCID: PMC10661602 DOI: 10.1186/s40792-023-01784-8] [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: 07/27/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND A colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF. CASE PRESENTATION A 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient's physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge. CONCLUSIONS A covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.
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Affiliation(s)
- Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan.
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kay Uehara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kohki Takeda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Tai Terayachi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Tetsuya Okino
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
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Ishibashi R, Sasaki T, Isayama H, Matsuzawa T, Kuwai T, Yamada T, Saito S, Tomita M, Shiratori T, Ikeda S, Kanazawa H, Fujishiro M, Maetani I, Saida Y. A Japanese Prospective, Multicenter Study of Colonic Stenting for Palliation Using a High Axial Force Self-Expandable Metal Stent for Malignant Large Bowel Obstruction in 200 Patients. J Clin Med 2023; 12:5134. [PMID: 37568537 PMCID: PMC10419878 DOI: 10.3390/jcm12155134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/10/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Evidence of the efficacy and safety of colorectal stent placement for palliation remains insufficient. This single-arm, prospective, multicenter study with a WallFlex enteral colonic stent included 200 consecutive patients with malignant large bowl obstruction in the palliation cohort. The technical and clinical success, as well as stent patency and complications as short-term (≤7 days) and long-term (>7 days) outcomes, of high axial force self-expandable metal stent (SEMS) placement was evaluated. The technical and clinical success rates were 98.5% and 94.5%, respectively. Non-recurrent colorectal obstruction at 1 year was 63.9%, and 71.2% of the patients remained free of recurrent colorectal obstruction until death or the last follow-up. Fifty-six patients (28.0%) received chemotherapy, and five patients were administered bevacizumab after stent placement. The overall complication rate was 47%, including four (2.0%) early-onset and ten (5.0%) late-onset perforations, mostly due to stent-edge injury. Only the use of a long SEMS was a risk factor for perforation. In conclusion, endoscopic colorectal stenting using high axial force SEMS is an effective and safe procedure for palliation in patients with malignant colorectal obstruction. However, care should be taken to avoid perforation at the stent edge when using a long SEMS.
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Affiliation(s)
- Rei Ishibashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (R.I.); (M.F.)
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
| | - Takeaki Matsuzawa
- Department of Surgery, Imusumiyoshi General Hospital, Saitama 354-0041, Japan;
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan;
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi 466-8650, Japan;
| | - Shuji Saito
- Department of Surgery, Gastrointestinal Center, Yokohama Shin-Midori General Hospital, Kanagawa 226-0025, Japan;
| | - Masafumi Tomita
- Department of Surgery, Kobe Tokushukai Hospital, Hyogo 655-0017, Japan;
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Chiba 296-8602, Japan;
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan;
| | - Hideki Kanazawa
- Department of Surgery, National Hospital Organization Sagamihara Hospital, Kanagawa 252-0392, Japan;
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (R.I.); (M.F.)
| | - Iruru Maetani
- Department of Gastroenterology, Sin-Kuki General Hospital, Saitama 346-8530, Japan;
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan;
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Ohno M, Nishida A, Nishino K, Hirayama H, Takahashi K, Morita Y, Kishi Y, Morita Y, Bamba H, Shiomi H, Imaeda H. Palliative stenting for malignant colorectal stenosis in the elderly. DEN OPEN 2023; 3:e168. [PMID: 36203782 PMCID: PMC9523547 DOI: 10.1002/deo2.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 11/13/2022]
Abstract
Objectives Self‐expandable metal stents are widely used for the treatment of malignant colorectal stenosis (MCS). In elderly individuals with MCS, self‐expandable metal stents are often used as a palliative treatment, but prophylactic stent placement is not recommended. We investigated the efficacy and safety of self‐expandable metal stents for the elderly in a palliative setting, specifically in a prophylactic setting. Methods Elderly patients with MCS who received a palliative stent (the stent group) or palliative stoma (the stoma group) were retrospectively enrolled between April 2017 and June 2022, and the prognosis and complication rates were assessed. Additionally, patients in the stent group were divided into symptomatic and asymptomatic subgroups, and prognosis, stent patency, and complication rates were evaluated. Results During the study period, 31 patients with a mean age of 85.4 years and 12 patients with a mean age of 82.0 years were enrolled in the stent and stoma groups, respectively. While overall survival and complication rates were comparable, the length of hospital stay was significantly shorter in the stent group. Of the 31 patients in the stent group, 16 asymptomatic patients received prophylactic stenting, which was not associated with increased complication rates. Conclusions Palliative stents for MCS appear to be effective and safe even in the elderly, and thus, prophylactic stents can be considered for asymptomatic patients.
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Affiliation(s)
- Masashi Ohno
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
- Department of Medicine Shiga University of Medical Science Shiga Japan
| | - Atsushi Nishida
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
- Department of Medicine Shiga University of Medical Science Shiga Japan
| | - Kyohei Nishino
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
| | - Hisashi Hirayama
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
| | - Kenichiro Takahashi
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
- Department of Medicine Shiga University of Medical Science Shiga Japan
| | - Yukihiro Morita
- Department of Medicine Shiga University of Medical Science Shiga Japan
- Department of Gastroenterology and Hepatology Hikone Municipal Hospital Shiga Japan
| | - Yuki Kishi
- Department of Gastroenterology and Hepatology Hikone Municipal Hospital Shiga Japan
| | - Yasuhiro Morita
- Department of Gastroenterology and Hepatology Nagahama Red Cross Hospital Shiga Japan
| | - Hiromichi Bamba
- Department of Gastroenterology and Hepatology Nagahama Red Cross Hospital Shiga Japan
| | - Hisanori Shiomi
- Department of Surgery Nagahama Red Cross Hospital Shiga Japan
| | - Hirotsugu Imaeda
- Department of Gastroenterology and Hepatology Nagahama City Hospital Shiga Japan
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Suzuki H, Tsujinaka S, Sato Y, Miura T, Shibata C. Oncologic impact of colonic stents for obstructive left-sided colon cancer. World J Clin Oncol 2023; 14:1-12. [PMID: 36699626 PMCID: PMC9850666 DOI: 10.5306/wjco.v14.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/07/2022] [Accepted: 01/01/2023] [Indexed: 01/10/2023] Open
Abstract
Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer (OLCC) in terms of both palliative treatment and bridge-to-surgery (BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in short-term outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.
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Affiliation(s)
- Hideyuki Suzuki
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Shingo Tsujinaka
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Yoshihiro Sato
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Tomoya Miura
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Chikashi Shibata
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
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Wu Y, Li X, Xiong F, Bao WD, Dai YZ, Yue LJ, Liu Y. Malignant obstruction in the ileocecal region treated by self-expandable stent placement under the fluoroscopic guidance: A case report. World J Clin Cases 2022; 10:11529-11535. [PMID: 36387795 PMCID: PMC9649550 DOI: 10.12998/wjcc.v10.i31.11529] [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: 06/26/2022] [Revised: 08/26/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction. Emergency surgery is the main treatment for patients presenting with an obstruction. However, this procedure is associated with a high mortality rate and frequent complications. The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure. However, obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.
CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region. He was contraindicated for general anesthesia and surgical enterostomy. The placement of a self-expandable metallic stent seems an alternative to surgery, although stenting in this area is thought to be difficult and few studies have been reported so far. After three attempts at different interventional approaches, a stent was successfully placed in the obstructed segment under fluoroscopic guidance. After the procedure, the patient's abdominal distension and abdominal pain were significantly better than before.
CONCLUSION For patients with proximal colonic obstruction, self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction. It has the characteristics of high safety and high patient tolerance. However, further study is still needed.
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Affiliation(s)
- Yu Wu
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Xi Li
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Fei Xiong
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Wei-Dong Bao
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yong-Zhou Dai
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Lin-Jun Yue
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yuan Liu
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
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Kuwai T, Tamaru Y, Kusunoki R, Yoshida S, Matsuzawa T, Isayama H, Maetani I, Shimada M, Yamada T, Saito S, Tomita M, Koizumi K, Shiratori T, Enomoto T, Saida Y. Long-term outcomes of standardized colonic stenting using WallFlex as a bridge to surgery: Multicenter prospective cohort study. Dig Endosc 2022; 34:840-849. [PMID: 34525244 PMCID: PMC9293325 DOI: 10.1111/den.14137] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The oncological outcomes, especially high recurrence rate, of bridge-to-surgery (BTS) self-expandable metallic stent (SEMS) placement remain concerning, emphasizing the necessity of standardized SEMS placement. However, its impact on long-term BTS outcomes is unknown. We investigated the long-term outcomes of BTS colonic stenting using standardized SEMS placement. METHODS This prospective, multicenter cohort study conducted at 46 hospitals in Japan (March 2012 to October 2013) included consecutive patients with stage II and III obstructive colorectal cancer managed with BTS SEMS placement. The SEMS placement technique was standardized by information dissemination among the participating hospitals. The primary outcome was overall survival (OS) after SEMS placement, and the secondary outcomes were relapse-free survival (RFS), recurrence, and short-term outcomes of SEMS placement and surgery. RESULTS The 1-, 3-, and 5-year OS rates were 94.1%, 77.4%, and 67.4% (Kaplan-Meier), respectively, with high technical success (99.0%, 206/208) and low perforation (1.9%, 4/208) rates. The 1-, 3-, and 5-year RFS rates were 81.6%, 65.6%, and 57.9% (Kaplan-Meier), respectively, and the overall recurrence rate was 31.0% (62/200). The RFS rate was significantly poorer in patients with perforation (n = 4) than in those without perforation (n = 196) (log-rank P = 0.017); moreover, perforation was identified as an independent factor affecting RFS (hazard ratio 3.31; 95% confidence interval 1.03-10.71, multivariate Cox regression). CONCLUSION This large, prospective, multicenter study revealed satisfactory long-term outcomes of BTS colonic stenting using a standardized SEMS insertion method, which might be specifically due to the reduced perforation rate. (UMIN000007953).
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Affiliation(s)
- Toshio Kuwai
- Department of GastroenterologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterHiroshimaJapan
| | - Yuzuru Tamaru
- Department of GastroenterologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterHiroshimaJapan
| | - Ryusaku Kusunoki
- Department of GastroenterologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterHiroshimaJapan
| | - Shuntaro Yoshida
- Department of Endoscopy and Endoscopic SurgeryGraduate School of MedicineThe University of TokyoTokyoJapan
| | | | - Hiroyuki Isayama
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Iruru Maetani
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineTokyoJapan
| | - Mamoru Shimada
- Department of SurgeryToyonaka Keijinkai HospitalOsakaJapan
| | - Tomonori Yamada
- Department of GastroenterologyJapanese Red Cross Nagoya Daini HospitalAichiJapan
| | - Shuji Saito
- Division of SurgeryGastrointestinal CenterYokohama Shin‐Midori General HospitalKanagawaJapan
| | | | - Koichi Koizumi
- Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Disease CenterKomagome HospitalTokyoJapan
| | | | - Toshiyuki Enomoto
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Yoshihisa Saida
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
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10
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Naruse N, Miyahara K, Sakata Y, Takamori A, Ito Y, Hidaka H, Sameshima R, Tsuruoka N, Shimoda R, Yamanouchi K, Noda T, Fujimoto K, Esaki M. Utility and safety of the self-expandable metallic colonic stent in Japanese patients who received systemic chemotherapy or palliative treatment for obstructive primary advanced colorectal cancer: A retrospective single-center medical chart evaluation. JGH Open 2022; 6:324-329. [PMID: 35601122 PMCID: PMC9120876 DOI: 10.1002/jgh3.12744] [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: 02/13/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
Background and Aim The present study aimed to compare the utility and safety of the colonic self-expandable metallic stent between patients with obstructive primary colorectal cancer who underwent chemotherapy or palliative treatment care and patients bridging for surgery. Methods The cases of 71 patients with colonic obstructive stenosis and in-dwelling stents who were hospitalized between May 2012 and April 2020 at Karatsu Red Cross Hospital were retrospectively analyzed. The patients were classified into three groups: bridging for curative surgery (group I), receiving systemic chemotherapy (group II-A), and receiving only palliative treatment (group II-B). Technical and clinical success rates and complication rates after stenting were evaluated. Results No significant differences were observed in the technical (procedure) success rates (group I: 100%; group II, 97.6% [II-A: 100%; II-B: 95.8%]). The total clinical success rate was 85.9% (61/71) and did not vary significantly among the groups (group I: 82.8%; group II 88.0% [II-A: 83.3%; II-B: 91.6%]). No significant differences were observed in the early complication rates between groups I and II and in the late complication rates between groups II-A and II-B. Nutrition status, general condition, tumor staging, and 1-year survival were poorer in group II than in group I. Conclusion The findings show that colonic stenting for malignant obstruction was performed successfully and safely both in patients who received systemic chemotherapy or palliative therapy and in patients bridging for curative surgery, regardless of risk status for malnutrition, poor general condition, cancer stage progression, and short survival.
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Affiliation(s)
- Naomi Naruse
- Department of Internal MedicineKaratsu Red Cross HospitalKaratsuJapan
- Department of Internal MedicineSaga University HospitalSagaJapan
| | - Koichi Miyahara
- Department of Internal MedicineKaratsu Red Cross HospitalKaratsuJapan
| | - Yasuhisa Sakata
- Department of Internal MedicineSaga University HospitalSagaJapan
| | - Ayako Takamori
- Division of Clinical Research CenterSaga University HospitalSagaJapan
| | - Yoichiro Ito
- Department of Internal MedicineKaratsu Red Cross HospitalKaratsuJapan
| | - Hidenori Hidaka
- Department of Internal MedicineKaratsu Red Cross HospitalKaratsuJapan
| | | | - Nanae Tsuruoka
- Department of Internal MedicineSaga University HospitalSagaJapan
| | - Ryo Shimoda
- Department of Internal MedicineSaga University HospitalSagaJapan
| | - Kohei Yamanouchi
- Department of Clinical Medical SciencesInternational University of Health and WelfareFukuokaJapan
| | - Takahiro Noda
- Department of Internal MedicineKaratsu Red Cross HospitalKaratsuJapan
| | - Kazuma Fujimoto
- Department of Clinical Medical SciencesInternational University of Health and WelfareFukuokaJapan
| | - Motohiro Esaki
- Department of Internal MedicineSaga University HospitalSagaJapan
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11
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Short-Term Outcomes of Colorectal Stenting Using a Low Axial Force Self-Expandable Metal Stent for Malignant Colorectal Obstruction: A Japanese Multicenter Prospective Study. J Clin Med 2021; 10:jcm10214936. [PMID: 34768456 PMCID: PMC8585095 DOI: 10.3390/jcm10214936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Endoscopic colorectal stenting with high technical success and safety is essential in discussing the oncological outcomes for the management of malignant colorectal obstruction. Mechanical properties of self-expandable metal stents are usually considered to affect clinical outcomes. (2) Methods: A multicenter, prospective study was conducted in Japan. A self-expandable metal stent with low axial force was inserted endoscopically. The primary endpoint was clinical success, defined as the resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events. Short-term outcomes of 7 days were evaluated in this study. (3) Results: Two hundred and five consecutive patients were enrolled. Three patients were excluded, and the remaining 202 patients were evaluated. The technical and clinical success rates were 97.5% and 96.0%, respectively. Major stent-related adverse events included stent migration (1.0%), insufficient stent expansion (0.5%), and stent occlusion (0.5%). No colonic perforation was observed. There were two fatal cases (1%) which were not related to stent placement. (4) Conclusions: The placement of self-expandable metal stents with low axial force is safe with no perforation and showed high technical and clinical success rates in short-term outcomes for the management of malignant colorectal obstruction.
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12
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Tang C, Chen YN, Lee YW, Tsai SW. Colovesical fistula with intravesical colonic stent migration. Asian J Surg 2021; 44:1581-1582. [PMID: 34511363 DOI: 10.1016/j.asjsur.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Chin Tang
- Division of Urology, Department of Surgery, Cathay General Hospital, 280 Renai Rd Sec.4, 106, Taipei, Taiwan.
| | - Yu-Nung Chen
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Yi-Wei Lee
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shu-Wei Tsai
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.
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13
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Uehara H, Yamazaki T, Iwaya A, Kameyama H, Komatsu M, Hirai M. Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II to III Obstructive Colorectal Cancer: A Retrospective Study. Ann Coloproctol 2021; 38:235-243. [PMID: 34256426 PMCID: PMC9263314 DOI: 10.3393/ac.2020.01067.0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/27/2021] [Indexed: 10/25/2022] Open
Abstract
Purpose We evaluated the oncological outcomes of bridge to surgery (BTS) using stent compared with surgery alone for obstructive colorectal cancer. Methods Consecutive patients who underwent curative resection for stages II to III obstructive colorectal cancer at our institution from January 2009 to March 2020, were registered retrospectively and divided into 43 patients in the BTS group and 65 patients in the surgery alone group. We compared the surgical and oncological outcomes between the 2 groups. Results Stent-related perforation did not occur. One patient in whom the stent placement was unsuccessful underwent emergency surgery with poor decompression (clinical success rate, 97.7%). The pathological characteristics were not significantly different between the groups. The following surgical outcomes in the BTS group were superior to those in the surgery alone group; nonemergency surgery (P<0.001), surgical approach (P=0.006), and length of hospital stay (P=0.020). The median follow-up time was 44.9 months (range, 1.1-126.5 months). The 3-year relapse-free survival rates were 68.4% and 58.2% (P=0.411), and the overall survival rates were 78.3% and 88.2% (P=0.255) in the surgery alone and BTS groups, respectively. The 3-year locoregional recurrence rates were 10.2% and 8.0% (P=0.948), and distant metastatic recurrence rates were 13.3% and 30.4% (P=0.035) in the surgery alone and BTS groups, respectively. Conclusion This study revealed that BTS with stent may be associated with a higher frequency of distant metastatic recurrence. Stent for stages II to III obstructive colorectal cancer potentially worsens oncological outcomes.
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Affiliation(s)
- Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Masaru Komatsu
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Motoharu Hirai
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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14
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Han B, Hong JY, Myung E, Oh HH, Yang HC, Kim SW, Lee J, Kim SJ, Han YD, Seo GS, Hong GY, Kim HD, Kim HS, Joo YE. Predictors of clinical outcomes of self-expandable metal stent treatment for malignant colorectal obstruction: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study. Medicine (Baltimore) 2021; 100:e26616. [PMID: 34232219 PMCID: PMC8270569 DOI: 10.1097/md.0000000000026616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/19/2021] [Indexed: 01/04/2023] Open
Abstract
There has been increased use of self-expandable metal stents (SEMS) in treating malignant colorectal obstruction (MCO). The aim of this study was to investigate factors that are associated with the outcomes of SEMS placement for MCO.Clinical data from patients who underwent SEMS placement for MCO at 6 hospitals in Honam province of South Korea between 2009 and 2018 were reviewed retrospectively. Eight hundred two patients were identified and their data were analyzed. Technical success, clinical success, complications, and predictors of outcome were included as main outcome measures.Technical and clinical success rates were 98.8% (792/802) and 90.1% (723/802), respectively. Complications including stent migration, stent occlusion due to tumor ingrowth and outgrowth, perforation, bacteremia/fever, and bleeding occurred in 123 (15.3%) patients. In multivariate regression analyses, procedure time was significantly associated with the technical success of SEMS placement (P = .001). Longer length of obstruction, the use of covered stent, and longer procedure time were significant independent predictive factors for the clinical success of SEMS placement (odds ratio [OR] 0.974 (95% confidence interval [CI] 0.950-0.990); P = .043, OR 0.255 (95% CI 0.138-0.471); P < .001, and OR 0.957 (95% CI 0.931-0.984); P = .002, respectively). Stage IV colorectal cancer and the use of covered stent were significant independent predictive factors for the development of complications after SEMS placement (OR 2.428 (95% CI 1.407-4.188); P = .001 and OR 3.329 (95% CI 2.060-5.378); P < .001, respectively).Longer length of obstruction, the use of covered stent, and longer procedure time were associated with lower clinical success rates. Having stage IV colorectal cancer and the use of covered stents were associated with an increased risk of complications.
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Affiliation(s)
- Bora Han
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji-Yun Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Myung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Chan Yang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Seong-Jung Kim
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Yeom-Dong Han
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Geom-Seok Seo
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Gun-Young Hong
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Republic of Korea
| | - Ho-Dong Kim
- Department of Internal Medicine, Saint Carollo Hospital, Suncheon, Republic of Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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15
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Yan FH, Zhang Y, Bian CL, Liu XS, Chen BC, Wang Z, Wang H, Ji-Fu E, Yu ED. Self-expanding metal stent insertion by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring in the management of acute colorectal obstruction: a 14-year experience. World J Surg Oncol 2021; 19:194. [PMID: 34215276 PMCID: PMC8254346 DOI: 10.1186/s12957-021-02309-z] [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: 02/20/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Placement of a self-expanding metal stent (SEMS) in patients presenting with an acute colorectal obstruction (ACO) may obviate emergency surgery (ES), potentially effectively palliating incurable tumors, acting as a bridge to surgery (BTS) in patients with operable or potentially operable tumors and achieving effective decompression of other ACO. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (AMCO) for nearly a 14-year period (2007-2020). AIM To explore the safety and effectiveness of SEMS insertion in the management of ACO by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring. METHODS We reviewed the medical records of patients retrospectively to identify all patients presenting to our unit with ACO especially with AMCO who had stenting carried out to achieve colonic decompression. All 434 procedures were performed by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring. RESULTS The overall technique success rate and clinic success rate by SEMS insertion were 428/434 (98.6%) and 412/434 (94.9%). The overall incidence of complications by SEMS insertion was 19/434 (4.4%). The complications included clinical perforation (6/434, 1.4%); stent migration (2/434, 0.5%), 1 of which re-stent; stent detachment (fell off) (3/434, 0.7%), none of them with re-stent; stool impaction (6/434, 1.4%), 1 of which re-stent; and abdominal or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients. CONCLUSIONS SEMS insertion is a relatively safe and effective technique for colonic decompression in dealing with ACO as either a BTS or as a palliative measure. It is also a solution to other causes of ACO such as recurrent tumor, benign diseases, or extra-luminal compression. Therefore, ES was largely avoided.
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Affiliation(s)
- Fei-Hu Yan
- Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China.,Department of Medical Statistics Faculty of Medical Services, PLA Navy Medical University, 200433, Shanghai, China
| | - Yao Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, China
| | - Cheng-Ling Bian
- Department of Radiology, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Xiao-Shuang Liu
- Department of General Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Bing-Chen Chen
- Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Zhen Wang
- Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China
| | - Hao Wang
- Department of General Surgery, Eastern Theater Naval Hospital, Zhoushan, 316000, China
| | - E Ji-Fu
- Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China.
| | - En-da Yu
- Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, China.
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16
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Podda M, Sylla P, Baiocchi G, Adamina M, Agnoletti V, Agresta F, Ansaloni L, Arezzo A, Avenia N, Biffl W, Biondi A, Bui S, Campanile FC, Carcoforo P, Commisso C, Crucitti A, De'Angelis N, De'Angelis GL, De Filippo M, De Simone B, Di Saverio S, Ercolani G, Fraga GP, Gabrielli F, Gaiani F, Guerrieri M, Guttadauro A, Kluger Y, Leppaniemi AK, Loffredo A, Meschi T, Moore EE, Ortenzi M, Pata F, Parini D, Pisanu A, Poggioli G, Polistena A, Puzziello A, Rondelli F, Sartelli M, Smart N, Sugrue ME, Tejedor P, Vacante M, Coccolini F, Davies J, Catena F. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project. World J Emerg Surg 2021; 16:35. [PMID: 34215310 PMCID: PMC8254305 DOI: 10.1186/s13017-021-00378-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. METHODS The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. CONCLUSIONS The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Gianluca Baiocchi
- ASST Cremona, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michel Adamina
- Department of Colorectal Surgery, Cantonal Hospital of Winterthur, Winterthur - University of Basel, Basel, Switzerland
| | | | - Ferdinando Agresta
- Department of General Surgery, Vittorio Veneto Hospital, AULSS2 Trevigiana del Veneto, Vittorio Veneto, Italy
| | - Luca Ansaloni
- 1st General Surgery Unit, University of Pavia, Pavia, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Nicola Avenia
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Antonio Biondi
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Simona Bui
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Fabio C Campanile
- Department of Surgery, ASL VT - Ospedale "San Giovanni Decollato - Andosilla", Civita Castellana, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Claudia Commisso
- Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Antonio Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital and Catholic University, Rome, Italy
| | - Nicola De'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Gian Luigi De'Angelis
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | | | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Federica Gaiani
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari K Leppaniemi
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andrea Loffredo
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA
| | | | | | - Dario Parini
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Polistena
- Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto I, Sapienza Università degli Studi di Roma, Rome, Italy
| | - Alessandro Puzziello
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Fabio Rondelli
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | | | | | - Michael E Sugrue
- Letterkenny University Hospital and CPM sEUBP Interreg Project, Letterkenny, Ireland
| | | | - Marco Vacante
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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Kaida T, Doi K, Yumoto S, Kinoshita S, Takeyama H, Ishiodori H, Baba H. Cost-effectiveness of self-expandable metallic stents as bridge to surgery for obstructive colorectal cancer. Int J Clin Oncol 2021; 26:1485-1491. [PMID: 33937958 DOI: 10.1007/s10147-021-01928-6] [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: 11/12/2020] [Accepted: 04/17/2021] [Indexed: 12/15/2022]
Abstract
AIM Self-expandable metallic stent (SEMS) placement is an emergent decompression approach for patients with obstructive colorectal cancer, alongside drainage tube (DT) and emergency surgery (ES). Few reports have compared the health care cost of each treatment. We aimed to compare the efficacy of SEMS as a bridge to surgery (BTS), including health care costs during decompression and colorectal resection, with those of DT and ES. METHODS This retrospective study enrolled patients treated for acute obstructed colorectal cancer at a single institution from January 2007 to December 2019. A total of 45 patients that underwent placement of a DT, emergency colostomy, or SEMS insertion followed by elective radical colectomy or rectectomy for obstructed colorectal cancer were included, and their data were analyzed. RESULTS Among 45 patients with obstructive colorectal cancer, 29 (55.6%) patients underwent SEMS, 7 (15.6%) underwent DT, and 9 (20.0%) underwent ES as BTS. The time to oral intake from the decompression treatment in the SEMS group was significantly shorter than that of the DT and ES group (1 vs. 13 vs. 3 day, p < 0.001). Total hospitalization during the decompression and colorectal resection in the SEMS group was significantly shorter that in the DT and ES groups (23 vs. 34 vs. 44 day, p < 0.001). The total health care cost for the decompression and the colorectal resection of DT and SEMS treatment was significantly less inexpensive than ES treatment (180.8 vs. 206.7 vs. 250.3 × 104 yen, p = 0.030). CONCLUSIONS SEMS insertion as a BTS might represent a cost-effective and safe approach compared to other treatments.
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Affiliation(s)
- Takayoshi Kaida
- Department of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan.
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Koichi Doi
- Department of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Shinsei Yumoto
- Department of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Shotaro Kinoshita
- Department of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Hideaki Takeyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Hiroyuki Ishiodori
- Department of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto, 860-8556, Japan
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Kwaan MR, Ren Y, Wu Y, Xirasagar S. Colonic Stent Use by Indication and Patient Outcomes: A Nationwide Inpatient Sample Study. J Surg Res 2021; 265:168-179. [PMID: 33940240 DOI: 10.1016/j.jss.2021.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/14/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Colonic stent placement can avoid urgent surgery for large bowel obstruction in selected patients. Population-wide stent utilization patterns and outcomes are unknown. MATERIALS AND METHODS Using retrospective, population-based, Nationwide Inpatient Sample data, we studied patients with colonic stents discharged during 2010-2015. The primary outcome was ostomy creation during the same hospitalization. Other outcomes were perforation or peritonitis, and in-hospital death. Associations of outcomes with stent indication were investigated, adjusting for patient-, admission-, and hospital characteristics. We estimated annual population-wide stent use volumes. RESULTS Of 4257 patients with stent placement (52% male, mean age 64.6 years), 9.9% had non-metastatic colon cancer, 12.9% metastatic colon cancer, 37.8% extracolonic malignancy (ECM), and 39.3% had benign obstruction. In 8.1% of patients, ostomy creation surgery was performed. Perforation or peritonitis occurred in 16.7%, and in-hospital death in 4.5%. Relative to ECM, ostomy creation was several-fold more likely among nonmetastatic colon cancer (adjusted odds ratio (OR) 3.4; 95%CI, 2.1-5.5), metastatic colon cancer (adjusted OR 2.5; 95%CI, 1.7-3.7), and benign obstruction patients (adjusted OR 3.1; 95%CI, 2.1-4.7). Benign obstruction was associated with high risk of perforation/peritonitis (adjusted OR 3.1 relative to non-metastatic CC (95%CI, 2.1-4.5)). Perforation/peritonitis was highly associated with inpatient death (adjusted OR 6.8 (95%CI, 4.9-9.5)). Annually, about 3,580 patients underwent stent placement, with benign obstruction showing an increasing trend (P=0.0002). CONCLUSIONS Over 75% of stent placements were done for patients with benign disease and ECM obstruction. Subsequent ostomy creation during the hospitalization was least likely among ECM patients. Rates of perforation/peritonitis in benign obstructions were concerningly high. (22.2%).
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Yang Ren
- University of South Carolina, Department of Computer Science and Engineering, Columbia, SC
| | - Yuqi Wu
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
| | - Sudha Xirasagar
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
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The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study. Ann Med Surg (Lond) 2020; 60:675-679. [PMID: 33282280 PMCID: PMC7708825 DOI: 10.1016/j.amsu.2020.11.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background The global pandemic of COVID-19 has changed cancer treatment environments. In Japan, cancer screenings were halted and the numbers of endoscopies and surgeries were restricted in some hospitals based on the state of emergency declared. Herein, we investigated the impact of the COVID-19 pandemic on the characteristics of colorectal cancer (CRC) patients in facilities that are on the frontline of both COVID-19 and cancer treatments. Patients and methods We retrospectively analyzed the cases of all of the CRC patients (n = 123) who underwent surgery at our regional cancer treatment center and tertiary emergency hospital in Japan during a 120-day period ranging from before to after the state of emergency declaration. CRC patients during the corresponding period in the previous year were also examined. Results Although the number of CRC patients did not show a significant change related to the pandemic, the incidence of obstructive CRCs significantly increased after the pandemic's start. The numbers of outpatients and colonoscopies both decreased, which could have resulted in the decrease of CRC patients detected by cancer screening during the pandemic. The numbers of symptomatic CRC patients and emergency admissions both increased significantly during the pandemic. Conclusion Our findings indicate the possibility that the discovery of CRCs in patients could be delayed due to the halt in screenings caused by the COVID-19 pandemic, resulting in the increase of obstructive CRCs. These results highlight the importance of cancer screening and suggest that the screening system for cancers should be reorganized before future pandemics. The proportion of obstructive CRC patients increased during the COVID-19 pandemic. During the COVID-19 pandemic, CRC patients were mainly detected by abdominal symptoms but not by cancer screening. It is possible that the delays in the detection and surgeries due to halted screenings promoted the CRC progression. The screening systems for cancer should be reorganize before a future pandemic of unknown infectious disease.
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Miyo M, Kato T, Takahashi Y, Miyake M, Toshiyama R, Hamakawa T, Sakai K, Nishikawa K, Miyamoto A, Hirao M. Short-term and long-term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy. Ann Gastroenterol Surg 2020; 4:676-683. [PMID: 33319158 PMCID: PMC7726680 DOI: 10.1002/ags3.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
AIM In response to the rising use of laparoscopic surgery, recent studies have shown that laparoscopic multivisceral resections for locally advanced colon cancer are safe, feasible, and provide acceptable oncological outcomes. However, the usefulness of laparoscopic multivisceral resection remains controversial. Here, we aimed to compare short-term and long-term outcomes between laparoscopic and open multivisceral resection approaches for treating locally advanced colon cancer. METHODS We retrospectively collected data on 1315 consecutive patients admitted to the National Hospital Organization, Osaka National Hospital, for surgical treatment of colorectal cancer between 2010 and 2017. We assessed invasiveness in terms of operating times, blood loss, and complications. Oncological outcomes included 5-year survival rates and recurrences. RESULTS We included 85 patients that underwent a colectomy with a multivisceral resection for locally advanced colon cancer; of these, 38 were treated with a laparoscopic approach and 47 were treated with an open approach. Compared to the open surgery group, the laparoscopic group had significantly less blood loss (median volume: 25 vs 140 mL, P <0.001), a lower complication rate (10.5% vs 29.8%, P = 0.036), and shorter hospital stays (12 vs 15 days, P = 0.028). After excluding patients with stage Ⅳ colon cancer, the groups showed similar pathologic outcomes and no significant differences in 5-year disease-free survival (73.9% vs 67.4%; P = 0.664) or 5-year overall survival (75.8% vs 67.7%; P = 0.695). CONCLUSION A laparoscopic approach for locally advanced colon cancer could be less invasive than an open approach without affecting oncological outcomes in selected patients.
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Affiliation(s)
- Masaaki Miyo
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takeshi Kato
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Takahashi
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Masakazu Miyake
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Reishi Toshiyama
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takuya Hamakawa
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenji Sakai
- National Hospital Organization Osaka National HospitalOsakaJapan
| | | | - Atsushi Miyamoto
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Motohiro Hirao
- National Hospital Organization Osaka National HospitalOsakaJapan
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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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Tao K, Kuwai T, Ishaq S, Enomoto T, Saida Y. Newly developed proximal release-type colonic stent placement for malignant lower rectal obstruction. VideoGIE 2020; 5:250-251. [PMID: 32529160 PMCID: PMC7280147 DOI: 10.1016/j.vgie.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kanae Tao
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Sauid Ishaq
- Gastroenterology Department, Dudley Group Hospitals, Birmingham City University, Birmingham, United Kingdom
| | - Toshiyuki Enomoto
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
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