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Sullivan J, Donohue A, Brown S. Colorectal Oncologic Emergencies: Recognition, Management, and Outcomes. Surg Clin North Am 2024; 104:631-646. [PMID: 38677826 DOI: 10.1016/j.suc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Colorectal cancer is the third most frequent type of malignancy in the United States, and the age at diagnosis is decreasing. Although the goal of screening is focused on prevention and early detection, a subset of patients inevitably presents as oncologic emergencies. Approximately 15% of patients with colorectal cancer will present as surgical emergencies, with the majority being due to either colonic perforation or obstruction. Patients presenting with colorectal emergencies are a challenging cohort, as they often present at an advanced stage with an increase in T stage, lymphovascular invasion, and metachronous liver disease.
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Affiliation(s)
- Joshua Sullivan
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA
| | - Alec Donohue
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA
| | - Shaun Brown
- Department of General Surgery, Womack Army Medical Center, 2817 Reilly Road, Fort Liberty, NC 28310, USA.
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2
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Pavlidis ET, Galanis IN, Pavlidis TE. Management of obstructed colorectal carcinoma in an emergency setting: An update. World J Gastrointest Oncol 2024; 16:598-613. [PMID: 38577464 PMCID: PMC10989363 DOI: 10.4251/wjgo.v16.i3.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced (stage II, III or even IV). Diagnosis is based on clinical presentation, plain abdominal radiogram, computed tomography (CT), CT colonography and positron emission tomography/CT. The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes remains unknown. For the most common left-sided obstruction, the first choice should be either emergency surgery or endoscopic decompression by self-expendable metal stents or tubes. The operative plan should be either one-stage or two-stage resection. One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma (colostomy or ileostomy). Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity. Two-stage resection (Hartmann's procedure) is safer and the most widely used despite temporally affecting quality of life. Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing. For the less common right-sided obstruction, one-stage surgical resection is more beneficial than endoscopic decompression. The role of minimally invasive surgery (laparoscopic or robotic) is a subject of debate. Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rupture and subsequent septic complications. The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates. Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes. Management plans are crucial and must be individualized to better fit each case.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioannis N Galanis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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3
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Martins D, Vaz-Pereira R, Ferreira C, Costa P, Pinto-de-Sousa J. Apple Core Unveiled: Malignant Colonic Obstruction Revealing an Unknown Rectosigmoid Neoplasm With Foreign Body Impaction. Cureus 2024; 16:e51536. [PMID: 38304657 PMCID: PMC10834070 DOI: 10.7759/cureus.51536] [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: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
This case report highlights a rare clinical scenario of a 46-year-old male presenting with constipation and fecaloid vomiting due to an impacted chicken bone within an unidentified rectosigmoid neoplasm, leading to acute malignant colonic obstruction. Emergent exploratory laparotomy revealed an impacted chicken bone lodged in a previously unknown rectosigmoid tumor. An anatomopathological examination revealed a mucinous adenocarcinoma with clear margins and one pericolic metastatic lymph node. The postoperative period was uneventful, and the patient was proposed for adjuvant chemotherapy. The abrupt onset of symptoms allowed for an early diagnosis, emphasizing the unexpected association between foreign body impaction and incidental malignant obstruction. This case underscores the complexity of managing foreign body ingestion in the gastrointestinal tract and emphasizes the crucial role of diagnostic imaging in surgical planning. Furthermore, it draws attention to the potential occurrence of colorectal cancer in younger individuals, emphasizing the necessity for clinical vigilance and screening strategies beyond conventional age recommendations.
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Affiliation(s)
- Daniela Martins
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
- General Surgery, Clinical Academic Centre Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Ricardo Vaz-Pereira
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Cátia Ferreira
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Pedro Costa
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - João Pinto-de-Sousa
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
- General Surgery, Clinical Academic Centre Trás-Os-Montes e Alto Douro, Vila Real, PRT
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4
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Aboelezz AF, Othman MO. Endoscopic Management of Colonic Obstruction. Gastrointest Endosc Clin N Am 2024; 34:141-153. [PMID: 37973225 DOI: 10.1016/j.giec.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
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Affiliation(s)
- Ahmad F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Faculty of Medicine, Tanta University, El Bahr Street, Tanta Qism 2, Tanta 1, Gharbia Governorate 31111, Egypt
| | - Mohamed O Othman
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Gastroenterology Section at Baylor St Luke's Medical Center, 7200 Cambridge Street. Suite 8A, Houston, TX 77030, USA.
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5
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef C, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford) 2023; 25:985-999. [PMID: 37471055 DOI: 10.1016/j.hpb.2023.05.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. METHODS This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term "early metachronous metastases" applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with "late metachronous metastases" applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSIONS The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jose M Ramia-Angel
- Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Center, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita Salute San Raffaele University & IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall D'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Lower Austria, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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6
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef K, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. Br J Surg 2023; 110:1161-1170. [PMID: 37442562 PMCID: PMC10416695 DOI: 10.1093/bjs/znad124] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. METHODS This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term 'early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term 'late metachronous metastases' applies to those detected after 12 months. 'Disappearing metastases' applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSION The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Centre, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | | | - Kees Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, Hepatopancreatobiliary Centre, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Centre for Global Health and Medicine, Tokyo, Japan
| | | | - Andres Valdivieso
- Hepatopancreatobiliary Surgery and Liver Transplant, HU Cruces, Bilbao, Spain
| | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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Savu E, Vasile L, Serbanescu MS, Alexandru DO, Gheonea IA, Pirici D, Paitici S, Mogoanta SS. Clinicopathological Analysis of Complicated Colorectal Cancer: A Five-Year Retrospective Study from a Single Surgery Unit. Diagnostics (Basel) 2023; 13:2016. [PMID: 37370913 DOI: 10.3390/diagnostics13122016] [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: 04/10/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Patients with primary colorectal cancer can present with obstructions, tumor bleeding, or perforations, which represent acute complications. This paper aimed to analyze and compare the clinical and pathological profiles of two patient groups: one with colorectal cancer and a related complication and another without any specific complication. We performed a five-year retrospective study on colorectal cancer patients admitted to a surgery unit and comparatively explored the main clinical and pathological features of the tumors belonging to the two groups. A total of 250 patients with colorectal cancer were included in the analysis. Of these, 117 (46.8%) had presented a type of complication. The comparative analysis that examined several clinical and pathological parameters showed a statistically significant difference for unfavorable prognosis factors in the group with complications. This was evident for features such as vascular and perineural invasion, lymph node involvement, pathological primary tumor stage, and TNM stage. Colorectal cancers with a related complication belonged to a group of tumors with a more aggressive histopathologic profile and more advanced stages. Furthermore, the comparable incidence of cases in the two groups of patients warrants further efforts to be made in terms of early detection and prognosis prediction of colorectal cancer.
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Affiliation(s)
- Elena Savu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Oncopediatrics, Clinical Emergency County Hospital, 200642 Craiova, Romania
| | - Liviu Vasile
- Department of Surgical Semiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
| | - Mircea-Sebastian Serbanescu
- Department of Medical Informatics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dragos Ovidiu Alexandru
- Department of Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Pirici
- Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stefan Paitici
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
- Department of General Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stelian Stefanita Mogoanta
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
- Department of General Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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8
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Grigorean VT, Erchid A, Coman IS, Liţescu M. Colorectal Cancer-The "Parent" of Low Bowel Obstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050875. [PMID: 37241107 DOI: 10.3390/medicina59050875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023]
Abstract
Introduction: Despite the improvement of early diagnosis methods for multiple pathological entities belonging to the digestive tract, bowel obstruction determined by multiple etiologies represents an important percentage of surgical emergencies. General data: Although sometimes obstructive episodes are possible in the early stages of colorectal cancer, the most commonly installed intestinal obstruction has the significance of an advanced evolutionary stage of neoplastic disease. Development of Obstructive Mechanism: The spontaneous evolution of colorectal cancer is always burdened by complications. The most common complication is low bowel obstruction, found in approximately 20% of the cases of colorectal cancer, and it can occur either relatively abruptly, or is preceded by initially discrete premonitory symptoms, non-specific (until advanced evolutionary stages) and generally neglected or incorrectly interpreted. Success in the complex treatment of a low neoplastic obstruction is conditioned by a complete diagnosis, adequate pre-operative preparation, a surgical act adapted to the case (in one, two or three successive stages), and dynamic postoperative care. The moment of surgery should be chosen with great care and is the result of the experience of the anesthetic-surgical team. The operative act must be adapted to the case and has as its main objective the resolution of intestinal obstruction and only in a secondary way the resolution of the generating disease. Conclusions: The therapeutic measures adopted (medical-surgical) must have a dynamic character in accordance with the particular situation of the patient. Except for certain or probably benign etiologies, the possibility of colorectal neoplasia should always be considered, in low obstructions, regardless of the patient's age.
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Affiliation(s)
- Valentin Titus Grigorean
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Anwar Erchid
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Ionuţ Simion Coman
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Mircea Liţescu
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
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9
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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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