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Pooyan A, Mansoori B, Wang C. Imaging of abdominopelvic oncologic emergencies. Abdom Radiol (NY) 2024; 49:823-841. [PMID: 38017112 DOI: 10.1007/s00261-023-04112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes.
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Affiliation(s)
- Atefe Pooyan
- Department of Radiology, UW Radiology-Roosevelt Clinic, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Bahar Mansoori
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA
| | - Carolyn Wang
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA.
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Scaglione M, Masala S, Tamburrini S, Lassandro G, Barbuto L, Romano L, Iacobellis F, Sica G, Crivelli P, Turilli D, Sandomenico F, Granata V, Patlas MN. Abdominal Emergencies in Cancer Patients. Can Assoc Radiol J 2024; 75:161-170. [PMID: 37192390 DOI: 10.1177/08465371231175521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
| | | | | | | | - Luigi Barbuto
- Department of General and Emergency Radiology, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, Naples, Italy
| | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | | | | | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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3
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Ginzberg SP, Wirtalla CJ, Keele LJ, Wachtel H, Kaufman EJ, Kelz RR. An acute care surgeon's dilemma: Operative vs. non-operative management of emergency general surgery conditions in patients with recent colorectal cancer treatment. Am J Surg 2024; 227:15-21. [PMID: 37741802 PMCID: PMC10841180 DOI: 10.1016/j.amjsurg.2023.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/03/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND This comparative effectiveness study examined outcomes of operative vs. non-operative management for emergency general surgery (EGS) conditions in patients with recent cancer treatment (RT). METHODS Medicare beneficiaries with a history of colorectal cancer hospitalized for an EGS condition (2016-2018) were identified. RT was defined as chemotherapy/radiation within 3 months prior to admission. Instrumental variable analysis assessed the impact of management on mortality and readmissions among survivors (30d, 60d, and 90d), for patients in whom there was clinical equipoise regarding optimal management strategy. RESULTS Of 26,097 patients, 13% had undergone RT. In both the RT and non-RT groups, the optimal management strategy was uncertain in 14%. Operative management conferred increased risk of mortality but not readmission in patients with RT compared to those without (90d mortality:+43%, p = 0.03; 90d readmission:+7.1%, p = 0.776). CONCLUSIONS In patients with RT for whom there is clinical equipoise regarding EGS management, operative intervention increases risk of mortality.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Luke J Keele
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elinore J Kaufman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania Health System, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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4
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Hosseini MS, Jahanshahlou F, Gol Mohammadi Senji A. The necessity of integrating telehealth and surgical oncology practice. INTERNATIONAL JOURNAL OF SURGERY OPEN 2023; 56:100643. [PMID: 38620106 PMCID: PMC10300057 DOI: 10.1016/j.ijso.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Mohammad-Salar Hosseini
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Jahanshahlou
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Gol Mohammadi Senji
- Department of General and Vascular Surgery, Tabriz University of Medical Science, Tabriz, Iran
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Fico V, Altieri G, Di Grezia M, Bianchi V, Chiarello MM, Pepe G, Tropeano G, Brisinda G. Surgical complications of oncological treatments: A narrative review. World J Gastrointest Surg 2023; 15:1056-1067. [PMID: 37405101 PMCID: PMC10315125 DOI: 10.4240/wjgs.v15.i6.1056] [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: 01/16/2023] [Revised: 02/03/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.
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Affiliation(s)
- Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | | | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Medicine and Surgery, Catholic School of Medicine, Rome 00168, Italy
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Taqi K, Kim D, Yip L, Laane C, Rana Z, Hameed M, Hamilton T, Stuart H. Emergency surgical consultation for cancer patients: identifying the prognostic determinants of health. World J Surg Oncol 2022; 20:232. [PMID: 35820927 PMCID: PMC9277930 DOI: 10.1186/s12957-022-02694-z] [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: 11/03/2021] [Accepted: 07/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with malignancy often require urgent surgical consultation for treatment or palliation of disease. The objective of this study is to explore the prognostic determinants affecting care in acute cancer-related surgical presentations and the effect on patient outcomes. MAIN BODY This is a retrospective review of patients referred to the acute general surgery (ACS) service at a tertiary hospital for management of cancer-related problem from July 2017 to September 2018. Patient demographics, course in hospital, and survival were recorded. Multivariant logistic regression and Kaplan-Meier estimates were performed. One hundred eighty-nine patients were identified (53% female) with a mean age of 65.9 years. Forty-two patients (22%) were newly diagnosed with cancer on presentation, and 94 (50%) patients had metastatic disease. Cancer staging was completed in 84% of patients, and 65% had multidisciplinary team (MDT) assessment during their hospital stay. Surgery was performed on 90 (48%) patients, of which 31.2% was with palliative intent. Overall mortality was 56% with 30- and 60-day mortality of 15% and 22%, respectively. The adjusted odds ratio (OR) for a 60-day mortality was high in patients presenting with new cancer diagnosis (OR 3.18, 95% CI 1.18-9.02, p=0.03), metastatic disease (OR 5.11, 95% CI 2.03-12.85, p=0.001), or systemic therapy on presentation (OR 3.46, 95% CI 1.30-9.22, p=0.013). CONCLUSION Emergency surgical referral is common in patients with malignancy. Surgical decision making can be challenging due to the heterogeneity of this population and their associated comorbidities. Optimizing prognostic determinants such as goal-directed palliative care, MDT discussions, and bridging to systemic therapy can improve patient outcomes.
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Affiliation(s)
- Kadhim Taqi
- Department of Surgery - Division of General Surgery, University of British Columbia, 2103, 638 Beach Crescent, Vancouver, BC, V6Z3H4, Canada.
| | - Diane Kim
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lily Yip
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Charlotte Laane
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Zeeshan Rana
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Morad Hameed
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Trevor Hamilton
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Heather Stuart
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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Stewart CL, Tran TB, Nguyen A, Zain J, Lai L, Fong Y, Woo Y. Cholecystectomy in patients with hematologic malignancies. Am J Surg 2021; 223:1157-1161. [PMID: 34711411 DOI: 10.1016/j.amjsurg.2021.10.037] [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: 07/28/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cholecystectomy in patients with hematologic malignancies remains poorly understood. METHODS We retrospectively evaluated patients with hematologic malignancies who underwent cholecystectomy at a single institution. RESULTS Of 313 patients who presented for evaluation of abdominal pain, 64 underwent cholecystectomy for acute cholecystitis (34.4%), gangrenous cholecystitis (21.9%), chronic cholecystitis (23.4%), and cholelithiasis (20%). Most had a history of hematopoietic cell transplantation (62.5%) and/or immunosuppressive medication within 30 days of consultation (82.8%). Ultrasound had a 39% false-negative rate for acute nongangrenous cholecystitis. Operative time was 92 ± 39 min, 7 were performed open, 10 had intraoperative transfusions, and 4 had grade 3+ complications. Intraoperative transfusion was associated with increased postoperative length of stay (p = 0.03). Open procedure, operative time, estimated blood loss, intraoperative transfusion, and complications were not associated with timing of surgery. CONCLUSIONS Patients with hematologic malignancies can safely undergo cholecystectomy. Length of postoperative stay for inpatients is associated with intraoperative blood transfusion.
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Affiliation(s)
| | - Thuy B Tran
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Andrew Nguyen
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Jasmine Zain
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Lily Lai
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Yanghee Woo
- Department of Surgery, City of Hope, Duarte, CA, USA.
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8
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Posttransplant Lymphoproliferative Disorder Status Post-Solid Organ Transplant Presenting to the Emergency Department: Single Institute Experience. J Comput Assist Tomogr 2021; 45:894-903. [PMID: 34347710 DOI: 10.1097/rct.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the clinical, laboratory, imaging, and pathology findings associated with emergency department presentations of posttransplant lymphoproliferative disorder (PTLD) after solid organ transplant (SOT). METHODS Fifteen patients presenting to a single tertiary care center between 2004 and 2019 with PTLD after SOT were identified from a pathology database. Twelve patients presenting through the emergency department were included in the study. Demographic, clinical, imaging, pathology, treatment, and outcome data were reviewed. RESULTS Among this 12 patient cohort (7 men; mean age, 44.2 years), transplant history included 4 combined kidney/pancreas, 4 kidney, 2 liver, 1 cardiac, and 1 lung. Mean time from transplant to diagnosis was 7.6 years. Posttransplant lymphoproliferative disorder was identified on initial computed tomography scans in 10 of 12 patients. The most common sites for PTLD development were the gastrointestinal tract (4/12) and liver (3/12). Outcomes included resolution of PTLD in 9 of 12 patients, with 3 patients dying within 6 months of diagnosis. CONCLUSIONS Posttransplant lymphoproliferative disorder is a serious consequence of solid organ transplantation that can present in various locations and with varied symptomatology in the emergency setting. Other posttransplant complications may present similarly including chronic rejection and infection. Posttransplant lymphoproliferative disorder should be considered in SOT patients presenting with worsening abdominal pain or constitutional symptoms, even with normal laboratory workup.
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9
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Morani AC, Hanafy AK, Marcal LP, Subbiah V, Le O, Bathala TK, Elsayes KM. Imaging of acute abdomen in cancer patients. Abdom Radiol (NY) 2020; 45:2287-2304. [PMID: 31758230 DOI: 10.1007/s00261-019-02332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.
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Affiliation(s)
- Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
| | - Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Leonardo P Marcal
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Vivek Subbiah
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ott Le
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Tharakeshwara K Bathala
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
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10
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“-Omas” presenting as “-itis”: acute inflammatory presentations of common gastrointestinal neoplasms. Emerg Radiol 2019; 26:433-448. [DOI: 10.1007/s10140-019-01678-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
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Miyasaka M, Noji T, Tanaka K, Nakanishi Y, Asano T, Ebihara Y, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Oncological emergency surgery for metachronous large and small bowel metastases after pancreaticoduodenectomy for pancreatic cancer: a case report. Surg Case Rep 2018; 4:99. [PMID: 30136098 PMCID: PMC6104413 DOI: 10.1186/s40792-018-0506-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/09/2018] [Indexed: 12/23/2022] Open
Abstract
Background A surgical case of metachronous metastases of pancreatic head cancer (PC) to the large and small bowel is extremely rare. Therefore, there are only a few reports about surgery for intestinal metastases from PC. An oncologic emergency is defined as an acute, potentially life-threatening condition in a cancer patient that developed directly or indirectly because of the malignant disease or cancer treatment. Case presentation A 63-year-old man with PC underwent pancreaticoduodenectomy after receiving neoadjuvant chemotherapy with gemcitabine and S-1. Histopathologically, the tumor was diagnosed as poorly differentiated, tubular adenocarcinoma, with pT2, N0, pStage IB according to the UICC classification, seventh edition. R0 was achieved. Three months after pancreatoduodenectomy, blood tests showed coagulation derangements with high C-reactive protein (CRP 11.30 mg/dl). Computed tomography (CT) scan revealed a 55-mm mass alongside the transverse colon. During 2 weeks of follow-up, the coagulation derangement and elevated CRP persisted. Repeat CT showed that the tumor enlarged to 65 mm, and an additional mass, 25 mm in diameter, was detected in the jejunum. He was hospitalized due to abdominal pain and diarrhea with persistent high fever and was inspected; however, there was no evidence for infections. With the understanding that his life-threatening symptoms were secondary to the underlying malignancy, extirpation of the tumors combined with partial resection of the transverse colon and the jejunum was performed on the eighth day of hospitalization, on an emergency basis. The lesions were identified as large and small bowel metastases from PC because histopathological examination revealed morphological features similar to the primary disease. Immediately after the emergency surgery, the fever resolved and the CRP level normalized. He was discharged and received nab-paclitaxel with gemcitabine chemotherapy for 2 months postoperatively. He selected for best supportive care after this. The patient died due to a relapse with mesenteric lymph node metastasis 7 months after the emergency surgery. Conclusion Surgery as an oncological emergency for selected patients could sometimes contribute to improving patient’s quality of life.
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Affiliation(s)
- Mamoru Miyasaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Iacobellis F, Perillo A, Iadevito I, Tanga M, Romano L, Grassi R, Nicola R, Scaglione M. Imaging of Oncologic Emergencies. Semin Ultrasound CT MR 2017; 39:151-166. [PMID: 29571552 DOI: 10.1053/j.sult.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
- Francesca Iacobellis
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alessandra Perillo
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Isabella Iadevito
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Michela Tanga
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Luigia Romano
- Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Roberto Grassi
- Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Refky Nicola
- Department of Radiology, SUNY-Upstate University and Medical Center, Syracuse, NY
| | - Mariano Scaglione
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK.
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Bosscher MRF, Bastiaannet E, van Leeuwen BL, Hoekstra HJ. Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies. Ann Surg Oncol 2015; 23:1803-14. [PMID: 26553441 PMCID: PMC4858551 DOI: 10.1245/s10434-015-4939-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies. METHODS This was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality. RESULTS During the study period, 207 patients experienced surgical oncologic emergencies-101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19-92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002). CONCLUSIONS Defining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.
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Affiliation(s)
- Marianne R F Bosscher
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Park S, Lee HJ, Kang CH, Kim YT. Successful Management of Airway Emergency in a Patient with Esophageal Cancer. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Bosscher MRF, van Leeuwen BL, Hoekstra HJ. Current management of surgical oncologic emergencies. PLoS One 2015; 10:e0124641. [PMID: 25933135 PMCID: PMC4416749 DOI: 10.1371/journal.pone.0124641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/16/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.
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Affiliation(s)
- Marianne R. F. Bosscher
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara L. van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harald J. Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
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Bosscher MRF, van Leeuwen BL, Hoekstra HJ. Mortality in emergency surgical oncology. Ann Surg Oncol 2014; 22:1577-84. [PMID: 25344307 DOI: 10.1245/s10434-014-4180-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE Cancer patients can experience problems related to their disease or treatment. This study evaluated reasons for presentation at the emergency room (ER) and outcome of surgical oncology patients. METHODS A retrospective chart review for all surgical oncology patients who presented at the ER of the UMCG for surgical consultation between October 1, 2012, and March 31, 2013. RESULTS A total of 200 cancer patients visited the ER for surgical consultation: 53.5 % with complications of (previous) cancer treatment, 25.5 % with symptoms caused by malignant disease, and 21.0 % with symptoms not related to cancer or cancer treatment. The 30-day mortality rate for patients with progressive disease was 25.5 %, and overall mortality rate was 62.8 %. The most frequent reason for ER presentation was intestinal obstruction (26.5 %), of which 41.5 % was malignant. Most cancer patients (59.5 %) did not undergo surgery during follow-up. The 30-day mortality for these patients was 14.3 % and overall mortality was 37.8 %. Most patients who died within the first 30 days after ER presentation had not undergone any surgery after presentation (89.5 %). CONCLUSIONS There is great variation in mortality rates for cancer patients presenting at the ER for surgical consultation. The mortality in this study was greatest for patients with progressive disease (30-day mortality 25.5 % and overall mortality 62.8 %), and the majority of patients who died within 30 days (89.5 %) had not undergone surgery after ER presentation. Surgery should only be performed in the acute setting when essential and when the expected outcome is favorable for the patient.
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Affiliation(s)
- M R F Bosscher
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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