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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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Calicis R, Dubois A, Ritter C, Tinton N, Calicis B, Hoebeke Y, Lepore D, Da Rocha De Sousa F, Cambier E, Corbisier F. Predictive factors of surgery in metastatic colorectal cancer: a retrospective cohort study. Acta Chir Belg 2024; 124:170-177. [PMID: 37605980 DOI: 10.1080/00015458.2023.2231211] [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: 01/23/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Current management of metastatic colorectal cancer is based on neoadjuvant chemotherapy. Few studies have reported on surgery procedures in patients with metastatic colorectal cancer. The objective of this study was to describe our institutional experience with emergency surgery performed in patients with metastatic colorectal cancer during chemotherapy. PATIENTS AND METHODS This was a retrospective cohort study including adult patients of ≤80 years with a metastatic colorectal cancer between 2017 and 2020 and undergoing surgery during chemotherapy. Statistical analyses were based on Kaplan-Meier's curve and Cox proportional hazard model. The surgery statistical risk during chemotherapy was studied through all tumor and patient's characteristics. Multivariable logistic regression models were used to identify predictive factors of emergency surgery in these patients. RESULTS Seventy-two cases were identified and 60% patients undergone an emergency surgery. By Kaplan-Meier's analyses, intestinal surgery was much more frequent and early in patients who have severe stenosis (either blocking or only permeable using a gastroscope) at the time of diagnosis. Patients with severe malignant stenosis presented a 6.28 time higher surgery risk (p < .0001). The median time between admission and surgery was 54 days in patients with severe stenosis who were operated. CONCLUSION The degree of colorectal tumor stenosis measured by endoscopy was a risk factor for emergency surgery in patients with metastatic colorectal cancer during neoadjuvant chemotherapy. In this group of patients presenting low survival outcomes, further studies are needed to define the place of preventive surgery, avoiding emergency surgery and morbidity in such fragile patients.
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Affiliation(s)
- Raffaele Calicis
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Antoine Dubois
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium
- Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels, Belgium
| | - Christian Ritter
- Statistical Methodology and Computing Service, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nicolas Tinton
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Benjamin Calicis
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Yves Hoebeke
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - David Lepore
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Emmanuel Cambier
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Fabrice Corbisier
- Department of Abdominal Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium
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Gao Y, Sun Y. Intestinal perforation due to colorectal cancer during pregnancy: case report and literature review. BMC Pregnancy Childbirth 2024; 24:374. [PMID: 38755532 PMCID: PMC11100117 DOI: 10.1186/s12884-024-06533-9] [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: 12/25/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Colorectal cancer (CRC) in pregnancy is sporadic. We reported a case of a woman at 23 + 4 weeks of gestation who presented with abdominal pain. The patient underwent an ultrasound and MRI, during which a colonic mass was noted. Considering a probable incomplete intestinal obstruction, a colonoscopy, biopsy, and colonic stenting were performed by a multidisciplinary team. However, sudden hyperthermia and CT demonstrated intestinal perforation, and an emergency caesarean section and colostomy were conducted. The histological analysis confirmed moderately high-grade adenocarcinoma.
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Affiliation(s)
- Yan Gao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
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4
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Evan C, Christy K, Hanafi RV, Rodjak MW. Acute intestinal obstruction due to meckel's diverticulum: A case report and literature review. Heliyon 2024; 10:e30514. [PMID: 38726165 PMCID: PMC11079245 DOI: 10.1016/j.heliyon.2024.e30514] [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: 12/05/2023] [Revised: 04/20/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction and Importance: Meckel's diverticulum is a rare congenital condition often detected incidentally. Meckel's diverticulum, a rare disease, may result in acute intestinal obstruction and is frequently misdiagnosed. This study aims to report a case of acute intestinal obstruction due to Meckel's diverticulum. Case presentation A 61-year-old Javanese man was admitted to the emergency room with a history of constipation, nausea, vomiting, and abdominal pain. Physical examination showed abdomen distention, tenderness in the lower quadrant, and hyperactive bowel sound. Rectal examination found that the rectal ampulla was collapsed. A plain abdominal Radiograph showed small bowel dilatation and air-fluid levels. The patient was diagnosed with small bowel obstruction due to suspected left-sided colon cancer and taken up for exploratory laparotomy. Clinical discussion On exploration, Meckel's diverticulum measuring 3.5 cm in length and with a 2 cm base was found about 70 cm proximal to the Bauhin valve; the thin part formed a band that entangled the small bowel. Ileo-ileal resection anastomosis was performed. Clinical discussion Meckel's diverticulum is an intestinal pouch caused by incomplete obliteration of the vitelline duct during gestation. This condition affects 2 % of the population and is within 2 feet of the Bauhin valve. The mesodiverticular band was found to be the source of the bowel obstruction. Surgical resection is required for complicated diverticulum. Conclusion Meckel's diverticulum can be difficult to diagnose and require a higher level of suspicion. Although Meckel's diverticulum is uncommon in adults, it should be considered a cause of small bowel obstruction.
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Affiliation(s)
- Cecilia Evan
- Department of General Surgery, Universitas Padjadjaran, Bandung, Indonesia
| | - Kezia Christy
- Department of General Surgery, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Maman Wastaman Rodjak
- Digestive Surgery Division, Department of General Surgery, Santo Yusup General Hospital, Bandung, Indonesia
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5
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Garrett C, Koh CE, Solomon MJ, Steffens D. The health-related quality of life of early-onset colorectal cancer patients: an Australian cross-sectional study. Colorectal Dis 2024. [PMID: 38745343 DOI: 10.1111/codi.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/16/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
AIM Early-onset colorectal cancer (EOCRC) patients are more likely to have advanced disease and undergo more aggressive treatment modalities. However, current literature investigating the health-related quality of life (HRQoL) of EOCRC patients is scarce. This study aimed to determine the HRQoL of an Australian cohort of EOCRC patients including a subset who underwent pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHOD A cross-sectional study of EOCRC patients treated at the Royal Prince Alfred Hospital, Sydney Australia was performed. Patients were divided into groups based on the time interval from their index operation: ≤2 years and >2 years. HRQoL was evaluated using the SF-36v2 questionnaire. RESULTS A total of 50 patients were included. For patients ≤2 years from surgery, the median physical component summary (PCS) and mental health component summary (MCS) scores were 53.3 (36.4-58.9) and 47.3 (37.5-55.7). In the >2 years group, the median PCS and MCS scores were 50.6 (43.3-57.7) and 50.2 (39.04-56.2), respectively. Stage I (vs. stage II) disease and emergency (vs. elective) surgery conferred poorer PCS scores in patients ≤2 years from surgery. No other variables impacted PCS or MCS scores in EOCRC patients in either group. CONCLUSIONS HRQoL of EOCRC patients was equivocal to the Australian population. Having an earlier stage of diagnosis and emergency index operation was associated with poorer levels of physical functioning in patients ≤2 years from surgery. However, because of the limitations of this study, these findings require validation in future large-scale prospective research.
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Affiliation(s)
- Celine Garrett
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Nakayama Y, Yamaguchi M, Tamaki K, Hidaka M. A case of acute appendicitis caused by obstruction due to caecal cancer. J Surg Case Rep 2024; 2024:rjae303. [PMID: 38752150 PMCID: PMC11095256 DOI: 10.1093/jscr/rjae303] [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: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
Acute appendicitis supposedly results from appendix obstruction caused by various conditions, including caecal cancer. Here, we report an adenocarcinoma found in the specimen of a 65-year-old man diagnosed with acute appendicitis. The adenocarcinoma was detected in the appendix stump after emergency laparoscopic appendectomy. The patient was diagnosed with caecal cancer based on post-operative lower endoscopy findings, and an additional laparoscopic right hemicolectomy was performed. Acute appendicitis can occur at any age and may require emergency surgery. It is a benign disease that can be cured entirely by appendectomy in most cases but may result from an underlying malignant disease in some cases, especially in patients >40 years of age. Thus, clinicians should consider the possibility of a malignancy while diagnosing and treating acute appendicitis.
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Affiliation(s)
- Yoko Nakayama
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda 694-0063, Shimane, Japan
| | - Minekazu Yamaguchi
- Department of General Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Shimane, Japan
| | - Kaho Tamaki
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda 694-0063, Shimane, Japan
| | - Masaaki Hidaka
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo City 693-8501, Shimane, Japan
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7
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Huang Y, Liao F, Zhan Z, Chen X, Chen H, Shu X. Efficacy and Safety Analysis of Emergency Endoscopic Self-Expanding Metal Stent Placement Without Fluoroscopic Assistance for Right-Sided Colonic Cancer Obstruction. Ann Surg Oncol 2024; 31:3212-3221. [PMID: 38349564 DOI: 10.1245/s10434-024-14909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/29/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Traditionally, surgical treatment is recommended for right-sided colonic cancer obstruction (RCCO); however, the literature comparing surgical or non-surgical procedures is lacking. METHODS Patients included in this study were divided into two groups: one group received elective surgery after self-expanding metal stent (SEMS) placement, i.e., the bridge to surgery (BTS) group, and one group received emergency surgery (ES). RESULTS Thirty-five patients were included in the BTS group and 60 patients underwent ES. The technical and clinical success rates for SEMS placement were 100% and 88.6%, respectively, while the short-term complication rates were 51.4% and 33.3% for the BTS and ES groups, respectively (p = 0.082). Overall, 2.9% and 3.3% of postoperative deaths occurred in the BTS and ES groups (p = 1.000). The 1-year overall survival (OS) rates were 91.4% and 88.3% (p = 0.840), 3-year OS rates were 85.7% and 81.7% (p = 0.860), and 5-year OS rates were 82.9% and 76.7% (p = 0.620) in the BTS and ES groups, respectively. No tumor recurrence was found in the BTS group but seven recurrences were found in the ES group (11.7%) [p = 0.091]. Laparoscopic surgery was chosen by 42.9% of patients in the BTS group and 26.7% of patients in the ES group (p = 0.104); however, the length of hospital stay (p = 0.001) was longer in the BTS group. CONCLUSIONS In the two groups, no differences were found in terms of postoperative complications and mortality as well as OS. The BTS group preferred to perform laparoscopic surgery and the technical success rate of stenting was high, therefore SEMS for RCCO was considered safe and feasible.
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Affiliation(s)
- Yunfeng Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhenyi Zhan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiang Chen
- Department of Emergency@Trauma Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haiming Chen
- Department of Emergency@Trauma Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, Rossi G, Tarasconi A, Tian BWCA, Bonati E, Mentz R, Mazzini FN, Campana JP, Gasser E, Kafka-Ritsch R, Felsenreich DM, Dawoud C, Riss S, Gomes CA, Gomes FC, Gonzaga RAT, Canton CAB, Pereira BM, Fraga GP, Zem LG, Cordeiro-Fonseca V, de Mesquita Tauil R, Atanasov B, Belev N, Kovachev N, Meléndez LJJ, Dimova A, Dimov S, Zelić Z, Augustin G, Bogdanić B, Morić T, Chouillard E, Bajul M, De Simone B, Panis Y, Esposito F, Notarnicola M, Lauka L, Fabbri A, Hentati H, Fnaiech I, Aurélien V, Bougard M, Roulet M, Demetrashvili Z, Pipia I, Merabishvili G, Bouliaris K, Koukoulis G, Doudakmanis C, Xenaki S, Chrysos E, Kokkinakis S, Vassiliu P, Michalopoulos N, Margaris I, Kechagias A, Avgerinos K, Katunin J, Lostoridis E, Nagorni EA, Pujante A, Mulita F, Maroulis I, Vailas M, Marinis A, Siannis I, Bourbouteli E, Manatakis DK, Tasis N, Acheimastos V, Maria S, Stylianos K, Kuzeridis H, Korkolis D, Fradelos E, Kavalieratos G, Petropoulou T, Polydorou A, Papacostantinou I, Triantafyllou T, Kimpizi D, Theodorou D, Toutouzas K, Chamzin A, Frountzas M, Schizas D, Karavokyros I, Syllaios A, Charalabopoulos A, Boura M, Baili E, Ioannidis O, Loutzidou L, Anestiadou E, Tsouknidas I, Petrakis G, Polenta E, Bains L, Gupta R, Singh SK, Khanduri A, Bala M, Kedar A, Pisano M, Podda M, Pisanu A, Martines G, Trigiante G, Lantone G, Agrusa A, Di Buono G, Buscemi S, Veroux M, Gioco R, Veroux G, Oragano L, Zonta S, Lovisetto F, Feo CV, Pesce A, Fabbri N, Lantone G, Marino F, Perrone F, Vincenti L, Papagni V, Picciariello A, Rossi S, Picardi B, Del Monte SR, Visconti D, Osella G, Petruzzelli L, Pignata G, Andreuccetti J, D'Alessio R, Buonfantino M, Guaitoli E, Spinelli S, Sampietro GM, Corbellini C, Lorusso L, Frontali A, Pezzoli I, Bonomi A, Chierici A, Cotsoglou C, Manca G, Delvecchio A, Musa N, Casati M, Letizia L, Abate E, Ercolani G, D'Acapito F, Solaini L, Guercioni G, Cicconi S, Sasia D, Borghi F, Giraudo G, Sena G, Castaldo P, Cardamone E, Portale G, Zuin M, Spolverato Y, Esposito M, Isernia RM, Di Salvo M, Manunza R, Esposito G, Agus M, Asti ELG, Bernardi DT, Tonucci TP, Luppi D, Casadei M, Bonilauri S, Pezzolla A, Panebianco A, Laforgia R, De Luca M, Zese M, Parini D, Jovine E, De Sario G, Lombardi R, Aprea G, Palomba G, Capuano M, Argenio G, Orio G, Armellino MF, Troian M, Guerra M, Nagliati C, Biloslavo A, Germani P, Aizza G, Monsellato I, Chahrour AC, Anania G, Bombardini C, Bagolini F, Sganga G, Fransvea P, Bianchi V, Boati P, Ferrara F, Palmieri F, Cianci P, Gattulli D, Restini E, Cillara N, Cannavera A, Nita GE, Sarnari J, Roscio F, Clerici F, Scandroglio I, Berti S, Cadeo A, Filippelli A, Conti L, Grassi C, Cattaneo GM, Pighin M, Papis D, Gambino G, Bertino V, Schifano D, Prando D, Fogato L, Cavallo F, Ansaloni L, Picheo R, Pontarolo N, Depalma N, Spampinato M, D'Ugo S, Lepre L, Capponi MG, Campa RD, Sarro G, Dinuzzi VP, Olmi S, Uccelli M, Ferrari D, Inama M, Moretto G, Fontana M, Favi F, Picariello E, Rampini A, Barberis A, Azzinnaro A, Oliva A, Totaro L, Benzoni I, Ranieri V, Capolupo GT, Carannante F, Caricato M, Ronconi M, Casiraghi S, Casole G, Pantalone D, Alemanno G, Scheiterle M, Ceresoli M, Cereda M, Fumagalli C, Zanzi F, Bolzon S, Guerra E, Lecchi F, Cellerino P, Ardito A, Scaramuzzo R, Balla A, Lepiane P, Tartaglia N, Ambrosi A, Pavone G, Palini GM, Veneroni S, Garulli G, Ricci C, Torre B, Russo IS, Rottoli M, Tanzanu M, Belvedere A, Milone M, Manigrasso M, De Palma GD, Piccoli M, Pattacini GC, Magnone S, Bertoli P, Pisano M, Massucco P, Palisi M, Luzzi AP, Fleres F, Clarizia G, Spolini A, Kobe Y, Toma T, Shimamura F, Parker R, Ranketi S, Mitei M, Svagzdys S, Pauzas H, Zilinskas J, Poskus T, Kryzauskas M, Jakubauskas M, Zakaria AD, Zakaria Z, Wong MPK, Jusoh AC, Zakaria MN, Cruz DR, Elizalde ABR, Reynaud AB, Hernandez EEL, Monroy JMVP, Hinojosa-Ugarte D, Quiodettis M, Du Bois ME, Latorraca J, Major P, Pędziwiatr M, Pisarska-Adamczyk M, Walędziak M, Kwiatkowski A, Czyżykowski Ł, da Costa SD, Pereira B, Ferreira ARO, Almeida F, Rocha R, Carneiro C, Perez DP, Carvas J, Rocha C, Ferreira C, Marques R, Fernandes U, Leao P, Goulart A, Pereira RG, Patrocínio SDD, de Mendonça NGG, Manso MIC, Morais HMC, Cardoso PS, Calu V, Miron A, Toma EA, Gachabayov M, Abdullaev A, Litvin A, Nechay T, Tyagunov A, Yuldashev A, Bradley A, Wilson M, Panyko A, Látečková Z, Lacko V, Lesko D, Soltes M, Radonak J, Turrado-Rodriguez V, Termes-Serra R, Morales-Sevillano X, Lapolla P, Mingoli A, Brachini G, Degiuli M, Sofia S, Reddavid R, de Manzoni Garberini A, Buffone A, Del Pozo EP, Aparicio-Sánchez D, Dos Barbeito S, Estaire-Gómez M, Vitón-Herrero R, de Los Ángeles Gil Olarte-Marquez M, Gil-Martínez J, Alconchel F, Nicolás-López T, Rahy-Martin AC, Pelloni M, Bañolas-Suarez R, Mendoza-Moreno F, Nisa FGM, Díez-Alonso M, Rodas MEV, Agundez MC, Andrés MIP, Moreira CCL, Perez AL, Ponce IA, González-Castillo AM, Membrilla-Fernández E, Salvans S, Serradilla-Martín M, Pardo PS, Rivera-Alonso D, Dziakova J, Huguet JM, Valle NP, Ruiz EC, Valcárcel CR, Moreno CR, Salazar YTM, García JJR, Micó SS, López JR, Farré SP, Gomez MS, Petit NM, Titos-García A, Aranda-Narváez JM, Romacho-López L, Sánchez-Guillén L, Aranaz-Ostariz V, Bosch-Ramírez M, Martínez-Pérez A, Martínez-López E, Sebastián-Tomás JC, Jimenez-Riera G, Jimenez-Vega J, Cuellar JAN, Campos-Serra A, Muñoz-Campaña A, Gràcia-Roman R, Alegre JM, Pinto FL, O'Sullivan SN, Antona FB, Jiménez BM, López-Sánchez J, Carmona ZG, Fernández RT, Sierra IB, de León LRG, Moreno VP, Iglesias E, Cumplido PL, Bravo AA, Simó IR, Domínguez CL, Caamaño AG, Lozano RC, Martínez MD, Torres ÁN, de Quiros JTMB, Pellino G, Cloquell MM, Moller EG, Jalal-Eldin S, Abdoun AK, Hamid HKS, Lohsiriwat V, Mongkhonsupphawan A, Baraket O, Ayed K, Abbassi I, Ali AB, Ammar H, Kchaou A, Tlili A, Zribi I, Colak E, Polat S, Koylu ZA, Guner A, Usta MA, Reis ME, Mantoglu B, Gonullu E, Akin E, Altintoprak F, Bayhan Z, Firat N, Isik A, Memis U, Bayrak M, Altıntaş Y, Kara Y, Bozkurt MA, Kocataş A, Das K, Seker A, Ozer N, Atici SD, Tuncer K, Kaya T, Ozkan Z, Ilhan O, Agackiran I, Uzunoglu MY, Demirbas E, Altinel Y, Meric S, Hacım NA, Uymaz DS, Omarov N, Balık E, Tebala GD, Khalil H, Rana M, Khan M, Florence C, Swaminathan C, Leo CA, Liasis L, Watfah J, Trostchansky I, Delgado E, Pontillo M, Latifi R, Coimbra R, Edwards S, Lopez A, Velmahos G, Dorken A, Gebran A, Palmer A, Oury J, Bardes JM, Seng SS, Coffua LS, Ratnasekera A, Egodage T, Echeverria-Rosario K, Armento I, Napolitano LM, Sangji NF, Hemmila M, Quick JA, Austin TR, Hyman TS, Curtiss W, McClure A, Cairl N, Biffl WL, Truong HP, Schaffer K, Reames S, Banchini F, Capelli P, Coccolini F, Sartelli M, Bravi F, Vallicelli C, Agnoletti V, Baiocchi GL, Catena F. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago. World J Emerg Surg 2024; 19:14. [PMID: 38627831 PMCID: PMC11020610 DOI: 10.1186/s13017-024-00543-w] [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: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.
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Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Mario Giuffrida
- General Surgery Unit, Maggiore Hospital, Parma, Italy.
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy.
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vitor F Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marco Livrini
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Antonio Tarasconi
- General Surgery Department, UO Chirurgia Generale, ASST Cremona, Cremona, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Elena Bonati
- General Surgery Unit, Maggiore Hospital, Parma, Italy
| | - Ricardo Mentz
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico N Mazzini
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan P Campana
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elisabeth Gasser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlos Augusto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Felipe Couto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Cassio Alfred Brattig Canton
- Medical Course, Department of Surgery - Emergency Surgery and Trauma Sector, Padre Albino University Center, Catanduva, Brazil
| | | | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Leticia Gonçalves Zem
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Boyko Atanasov
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikolay Belev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikola Kovachev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - L Juan José Meléndez
- Trauma and Acute Care Surgeon Hospital Rafael Angel Calderón Guardia, San José, Costa Rica
| | - Ana Dimova
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Stefan Dimov
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Zdravko Zelić
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branko Bogdanić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Trpimir Morić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Elie Chouillard
- Department of General and Bariatric Surgery, American Hospital in Paris, Paris, France
| | - Melinda Bajul
- Emergency and General Minimally Invasive Surgery, Poissy and St Germain Hospital, Poissy, France
| | - Belinda De Simone
- Department of Emergency and General Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve-Saint-Georges, France
| | - Yves Panis
- Colorectal Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Francesco Esposito
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | | | | | - Venara Aurélien
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Marie Bougard
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Maxime Roulet
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | | | - Irakli Pipia
- N.Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | | | | | | | - Sofia Xenaki
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Stamatios Kokkinakis
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | | | | | - Ioannis Margaris
- 4th Surgical Department "Attikon" University Hospital, Chaidari, Greece
| | | | | | - Jevgeni Katunin
- Department of Digestive Surgery, Athens Bioclinic Hospital, Athens, Greece
| | | | | | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Michail Vailas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Athanasios Marinis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Ioannis Siannis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Eirini Bourbouteli
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | | | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | | | | | - Dimitrios Korkolis
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Evangelos Fradelos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - George Kavalieratos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | | | | | | | - Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Despina Kimpizi
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | | | - Alexandros Chamzin
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Maximos Frountzas
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Boura
- National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratia Baili
- National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Ioannidis
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Lydia Loutzidou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Elissavet Anestiadou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Ioannis Tsouknidas
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Georgios Petrakis
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Eleni Polenta
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Sudhir K Singh
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Archana Khanduri
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Miklosh Bala
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Kedar
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marcello Pisano
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Mauro Podda
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Gennaro Martines
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuseppe Trigiante
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuliano Lantone
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Antonino Agrusa
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Massimiliano Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Rossella Gioco
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Gastone Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Luigi Oragano
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | - Sandro Zonta
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | | | - Carlo V Feo
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Antonio Pesce
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Giulio Lantone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabio Marino
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabrizio Perrone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Leonardo Vincenti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Vincenzo Papagni
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Arcangelo Picciariello
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | | | - Diego Visconti
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giulia Osella
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Luca Petruzzelli
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giusto Pignata
- Chirurgia Generale 2 ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | - Stefano Spinelli
- Chirurgia Generale PO Valle d'Itria ASL TA, Martina Franca, Italy
| | | | - Carlo Corbellini
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Leonardo Lorusso
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Alice Frontali
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Isabella Pezzoli
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandro Bonomi
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Chierici
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Giuseppe Manca
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Antonella Delvecchio
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Nicola Musa
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | | | - Laface Letizia
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Emmanuele Abate
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Giorgio Ercolani
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Fabrizio D'Acapito
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Leonardo Solaini
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Gianluca Guercioni
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Simone Cicconi
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Diego Sasia
- Santa Croce and Carle Hospital, Cuneo, Italy
| | | | | | - Giuseppe Sena
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Pasquale Castaldo
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Eugenia Cardamone
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | | | | | | | - Romina Manunza
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | - Marcello Agus
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | | | | | - Davide Luppi
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Massimiliano Casadei
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Angela Pezzolla
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | | | - Rita Laforgia
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | - Maurizio De Luca
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Monica Zese
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Dario Parini
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Elio Jovine
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giuseppina De Sario
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Raffaele Lombardi
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giovanni Aprea
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giuseppe Palomba
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Marianna Capuano
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giulio Argenio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gianluca Orio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Marina Troian
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Martina Guerra
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Carlo Nagliati
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Alan Biloslavo
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Paola Germani
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Giada Aizza
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Igor Monsellato
- SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Fransvea
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Bianchi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Boati
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Palmieri
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Pasquale Cianci
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Domenico Gattulli
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Nicola Cillara
- Chirurgia Generale PO Santissima Trinità - ASL Cagliari, Cagliari, Italy
| | | | - Gabriela Elisa Nita
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Jlenia Sarnari
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Roscio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Federico Clerici
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Ildo Scandroglio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Stefano Berti
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alessandro Cadeo
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alice Filippelli
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Luigi Conti
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Carmine Grassi
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | - Marina Pighin
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | - Davide Papis
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | | | | | | | - Daniela Prando
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luisella Fogato
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Fabio Cavallo
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luca Ansaloni
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Roberto Picheo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Nicholas Pontarolo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Norma Depalma
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Marcello Spampinato
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Stefano D'Ugo
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Luca Lepre
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Michela Giulii Capponi
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Rossella Domenica Campa
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Giuliano Sarro
- G.Fornaroli" Hospital, Magenta ASST Ovest Milanese, Milan, Italy
- Istituto Clinico San Gaudenzio - Novara, Novara, Italy
| | | | | | | | | | - Marco Inama
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Gianluigi Moretto
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Michele Fontana
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Francesco Favi
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Alessia Rampini
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Andrea Barberis
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Antonio Azzinnaro
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Alba Oliva
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | | | | | - Gabriella Teresa Capolupo
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Maurizio Ronconi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Silvia Casiraghi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Giovanni Casole
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Desire Pantalone
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Giovanni Alemanno
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Maximilian Scheiterle
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | | | | | | | - Federico Zanzi
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Stefano Bolzon
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Enrico Guerra
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Francesca Lecchi
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola Cellerino
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Ardito
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rosa Scaramuzzo
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | | | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Claudio Ricci
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Torre
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Iris Shari Russo
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Rottoli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marta Tanzanu
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Belvedere
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Milone
- University of Naples "Federico II", Naples, Italy
| | | | | | - Micaela Piccoli
- General Surgery,Emergencies and New Technologies, Baggiovara Civil Hospital Modena, Baggiovara, Italy
| | | | - Stefano Magnone
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bertoli
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Massucco
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | - Marco Palisi
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | | | - Francesco Fleres
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Guglielmo Clarizia
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Alessandro Spolini
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | | | | | | | | | | | | | - Saulius Svagzdys
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Henrikas Pauzas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justas Zilinskas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Matas Jakubauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Asri Che Jusoh
- Department of General Surgery, Hospital Sultan Ismail Petra, Kuala Krai, Kelantan, Malaysia
| | | | - Daniel Rios Cruz
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Aurea Barbara Rodriguez Elizalde
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Alejandro Bañon Reynaud
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | | | | | | | | | | | | | - Piotr Major
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Łukasz Czyżykowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | | | - Bela Pereira
- Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal
| | | | - Filipe Almeida
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ricardo Rocha
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Carla Carneiro
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Diego Pita Perez
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - João Carvas
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - Catarina Rocha
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | | | | | | | - Pedro Leao
- General Surgery Grupo Trofa Saúde, Porto, Portugal
| | | | - Rita Gonçalves Pereira
- General Surgery Department, Centro Hospitalar Barreiro Montijo, E.P.E., Barreiro, Portugal
| | | | | | | | | | | | - Valentin Calu
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adrian Miron
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Elena Adelina Toma
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Abakar Abdullaev
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Taras Nechay
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Alexander Tyagunov
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Anvar Yuldashev
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | | | | | - Arpád Panyko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Zuzana Látečková
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Vladimír Lacko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Dusan Lesko
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Marek Soltes
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Jozef Radonak
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Victor Turrado-Rodriguez
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Roser Termes-Serra
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Xavier Morales-Sevillano
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Pierfrancesco Lapolla
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Silvia Sofia
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | | | | | | | | | | | - Mercedes Estaire-Gómez
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rebeca Vitón-Herrero
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - José Gil-Martínez
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Felipe Alconchel
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Tatiana Nicolás-López
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Aida Cristina Rahy-Martin
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - María Pelloni
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Raquel Bañolas-Suarez
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Manuel Díez-Alonso
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Silvia Salvans
- Emergency Surgery Unit, Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Pablo Sancho Pardo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - Jana Dziakova
- Hospital Clínico San Carlos in Madrid, Madrid, Spain
| | | | | | | | | | | | | | - Juan Jesús Rubio García
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Sevila Micó
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joaquín Ruiz López
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Alberto Titos-García
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Jose Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Laura Romacho-López
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Luis Sánchez-Guillén
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Veronica Aranaz-Ostariz
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marina Bosch-Ramírez
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | - Elías Martínez-López
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | | | - Granada Jimenez-Riera
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Javier Jimenez-Vega
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Jose Aurelio Navas Cuellar
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | | | - Anna Muñoz-Campaña
- Emergency Surgery Unit at Hospital Universitari Parc Tauli, Sabadell, Spain
| | | | - Javier Martínez Alegre
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Francisca Lima Pinto
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Sara Nuñez O'Sullivan
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | | | | | - Jaime López-Sánchez
- General Surgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | | | | | | | - Eva Iglesias
- Hospital Universtario Puerta de Hierro, Madrid, Spain
| | | | | | - Ignacio Rey Simó
- HPB and Transplantation Unit, Head of Emergency Surgery Unit, Seville, Spain
| | | | | | - Rafael Calleja Lozano
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Manuel Durán Martínez
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Álvaro Naranjo Torres
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | | | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ahmed K Abdoun
- Department of Sugery, Almoalem Medical City, Khartoum, Sudan
| | | | - Varut Lohsiriwat
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Aitsariya Mongkhonsupphawan
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Oussama Baraket
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Karim Ayed
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Imed Abbassi
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | | | | | | | - Elif Colak
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | - Suleyman Polat
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | | | - Ali Guner
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Mehmet Arif Usta
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Murat Emre Reis
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Baris Mantoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emrah Akin
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Necattin Firat
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Arda Isik
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ufuk Memis
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | | | | | - Yasin Kara
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Seker
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nazmi Ozer
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Semra Demirli Atici
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Korhan Tuncer
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Kaya
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Zeynep Ozkan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Onur Ilhan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Ibrahim Agackiran
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | | | - Eren Demirbas
- Department of General Surgery, Bursa Kestel State Hospital, Kestel, Turkey
| | - Yuksel Altinel
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Derya Salim Uymaz
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Giovanni D Tebala
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hany Khalil
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mridul Rana
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mansoor Khan
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | - Cosimo Alex Leo
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Lampros Liasis
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Josef Watfah
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | | | - Edward Delgado
- Hospital de ClínicasClínica Quirúrgica ¨F¨, Montevideo, Uruguay
| | | | - Rifat Latifi
- Department of Surgery, School of Medicine, Westchester Medical Center, New York Medical College, Valhalla, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Sara Edwards
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ana Lopez
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - George Velmahos
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ander Dorken
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony Gebran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amanda Palmer
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - Jeffrey Oury
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - James M Bardes
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | | | | | | | | | | | | | | | | | | | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, USA
| | - Tyler R Austin
- Department of Surgery, University of Missouri, Columbia, USA
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | | | - Vanni Agnoletti
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Pezzullo F, Comune R, D'Avino R, Mandato Y, Liguori C, Lassandro G, Tamburro F, Galluzzo M, Scaglione M, Tamburrini S. CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer. LA RADIOLOGIA MEDICA 2024; 129:525-535. [PMID: 38512630 DOI: 10.1007/s11547-024-01778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). METHODS Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed. RESULTS Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients. CONCLUSION Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.
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Affiliation(s)
- Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaelle D'Avino
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ylenia Mandato
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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10
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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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11
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Monahan BV, Patel T, Poggio JL. Stage IV Colorectal Cancer at Initial Presentation versus Progression during and after Treatment, Differences in Management: Management Differences for Initial Presentation versus Progression of Disease after Initial Treatment. Clin Colon Rectal Surg 2024; 37:108-113. [PMID: 38322603 PMCID: PMC10843884 DOI: 10.1055/s-0043-1761626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Stage IV colorectal cancer is a prevalent disease and understanding the appropriate treatment options is important. Medical oncologic treatment remains the mainstay of treatment in cases where curative resection is not possible. Surgical intervention is indicated if the primary tumor and associated metastases are amenable to curative resection or if obstructive, bleeding, or perforative complications arise from the tumor. New endoscopic techniques can provide palliation and benefit for patients who cannot undergo surgery and may speed time to chemotherapy initiation. Recently, immunotherapy has shown promise at managing, controlling, and regressing advanced disease, in some cases converting it to curative with resection. For patients that progress while on treatment, continued medical therapy remains the mainstay of treatment. Further research into the benefits of asymptomatic primary tumor resection without curative intent needs to be performed. Colorectal cancer, and more specifically metastatic colorectal cancer, continues to have improved 1- and 5-year survival rates and likely will continue to do so over the coming months and years.
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Affiliation(s)
- Brian V. Monahan
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Takshaka Patel
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Juan Lucas Poggio
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
- Division of Colorectal Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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12
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Suzuki T, Matsumoto A, Akao T, Matsumoto H. Robotic high anterior resection for rectal cancer with hand-sewn Gambee anastomosis after metal stent placement in a colorectal malignant stricture: A case report. Int J Surg Case Rep 2024; 116:109383. [PMID: 38350378 PMCID: PMC10943974 DOI: 10.1016/j.ijscr.2024.109383] [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: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Robot-assisted surgery is increasingly deployed in colorectal surgery, and decompression surgery using a stent is considered a standard treatment for malignant stenosis of the large intestine. Surgery after stent placement is also frequently performed. However, the anastomosis method remains controversial. PRESENTATION OF CASE A 75-year-old woman visited our hospital's internal medicine department with chief complaints of bloody stool and constipation for the past year and colonoscopy was scheduled. After taking laxatives to prepare for treatment, abdominal pain was noticed and an emergency request was made. A diagnosis of colorectal malignant stricture and rectosigmoid junction cancer was made and a stent was placed during emergency colonoscopy. After intestinal decompression, a diagnosis of rectosigmoid junction cancer (UICC 8th; T3N0M0 Stage IIa) was rendered and robotic-assisted high anterior resection of the rectum and lymph node D3 dissection were performed. Reconstruction was performed using Gambee anastomosis outside the body cavity. The postoperative course was uneventful. DISCUSSION The double stapling technique is simple, but in this case, the obstructed intestinal tract was swollen. Meanwhile, Gambee anastomosis, which allows adjustment of tightness, was considered effective. CONCLUSION Gambee anastomosis is a valid option when robot-assisted rectal resection is performed after intestinal decompression with stent placement for malignant stricture of the rectosigmoid junction. It is important to select a hand-sewn or mechanical anastomosis by considering the condition of the organ to be anastomosed and the site of the anastomosis.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama 348-8505, Japan.
| | - Akiyo Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama 348-8505, Japan
| | - Takahiko Akao
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama 348-8505, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama 348-8505, Japan
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13
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Mauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel) 2024; 16:821. [PMID: 38398212 PMCID: PMC10887189 DOI: 10.3390/cancers16040821] [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: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients' management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine, PhD in Experimental Medicine Italy, University of Pavia, 27100 Pavia, Italy
| | - Sabrina Borgetto
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Fugazzola
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Ilaria Perretti
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Anna Gallotti
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Luca Ansaloni
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
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14
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Hussain MI, Piozzi GN, Sakib N, Duhoky R, Carannante F, Khan JS. Laparoscopic versus Open Emergency Surgery for Right Colon Cancers. Diagnostics (Basel) 2024; 14:407. [PMID: 38396446 PMCID: PMC10888455 DOI: 10.3390/diagnostics14040407] [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: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A laparoscopic approach to right colectomies for emergency right colon cancers is under investigation. This study compares perioperative and oncological long-term outcomes of right colon cancers undergoing laparoscopic or open emergency resections and identifies risk factors for survival. METHODS Patients were identified from a prospectively maintained institutional database between 2009 and 2019. Demographics, clinicopathological features, recurrence, and survival were investigated. Cox regression analysis was performed for risk factor analysis. RESULTS A total of 202 right colectomies (114 open and 88 laparoscopic) were included. ASA III-IV was higher in the open group. The conversion rate was 14.8%. Laparoscopic surgery was significantly longer (156 vs. 203 min, p < 0.001); pTNM staging did not differ. Laparoscopy was associated with higher lymph node yield, and showed better resection clearance (R0, 78.9 vs. 87.5%, p = 0.049) and shorter postoperative stay (12.5 vs. 8.0 days, p < 0.001). Complication rates and grade were similar. The median length of follow-up was significantly higher in the laparoscopic group (20.5 vs. 33.5 months, p < 0.001). Recurrences were similar (34.2 vs. 36.4%). Open surgery had lower five-year overall survival (OS, 27.1 vs. 51.7%, p = 0.001). Five-year disease-free survival was similar (DFS, 55.8 vs. 56.5%). Surgical approach, pN, pM, retrieved LNs, R stage, and complication severity were risk factors for OS upon multivariate analysis. Pathological N stage and R stage were risk factors for DFS upon multivariate analysis. CONCLUSIONS A laparoscopic approach to right colon cancers in an emergency setting is safe in terms of perioperative and long-term oncological outcomes. Randomized control trials are required to further investigate these results.
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Affiliation(s)
- Mohammad Iqbal Hussain
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Guglielmo Niccolò Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Najmu Sakib
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Rauand Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
- University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Jim S. Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
- University of Portsmouth, Portsmouth PO1 2UP, UK
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15
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Kanno DT, Mattos RLMD, Siqueira RM, Pereira JA, Campos FG, Martinez CAR. IMPACT OF THE COVID-19 PANDEMIC ON THE EMERGENCY SURGICAL TREATMENT OF COLORECTAL CANCER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 36:e1793. [PMID: 38324854 PMCID: PMC10841527 DOI: 10.1590/0102-672020230075e1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/10/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and the third most common type of cancer worldwide. The COVID-19 pandemic, during the years 2020 and 2022, increased the difficulties in offering adequate early diagnosis and treatment to CRC patients worldwide. During this period, it was only possible to treat patients who evolved with complications, mainly intestinal obstruction and perforation. AIMS To assess the impact of the COVID-19 pandemic on the treatment of patients with CRC. METHODS A review of data from a total of 112 patients undergoing emergency surgical treatment due to complications of CRC was carried out. Of these, 78 patients underwent emergency surgery during the COVID-19 pandemic (2020/2021), and 34 were treated before the pandemic (2018/2019). Ethnic aspects, clinical symptoms, laboratory tests, histopathological variables, intra and postoperative complications, and 90-day postoperative follow-up were compared between the two groups. RESULTS Between the years 2018 and 2019, 79.4% (27/34) of patients had intestinal obstruction, while 20.6% (7/34) had intestinal perforation. During the period of the COVID-19 pandemic (2020/2021), 1.3% (1/78) of patients underwent surgery due to gastrointestinal bleeding, 6.4% (5/78) due to intestinal perforation, and 92.3% (72/78) due to intestinal obstruction. No statistically significant differences were recorded between the two groups in ethnic aspects, laboratory tests, type of complications, number of lymph nodes resected, compromised lymph nodes, TNM staging, pre or intraoperative complications, length of stay, readmission, or mortality rate. When considering postoperative tumor staging, among patients operated on in 2018/2019, 44.1% were classified as stage III and 38.2% as stage IV, while during the pandemic period, 28.2% presented stage III and 51.3% stage IV, also without a statistically significant difference between the two periods. Patients operated on during the pandemic had higher rates of vascular, lymphatic and perineural invasion. CONCLUSIONS The COVID-19 pandemic increased the rate of complications related to CRC when comparing patients treated before and during the pandemic. Furthermore, it had a negative impact on histopathological variables, causing worse oncological prognoses in patients undergoing emergency surgery.
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Affiliation(s)
- Danilo Toshio Kanno
- Universidade São Francisco, Postgraduate Program in Health Sciences - Bragança Paulista (SP), Brazil
| | | | - Rayama Moreira Siqueira
- Universidade Estadual de Campinas, Department of Surgery, Postgraduate Program in Surgical Sciences - Campinas (SP), Brazil
| | - José Aires Pereira
- Universidade São Francisco, Postgraduate Program in Health Sciences - Bragança Paulista (SP), Brazil
| | | | - Carlos Augusto Real Martinez
- Universidade São Francisco, Postgraduate Program in Health Sciences - Bragança Paulista (SP), Brazil
- Universidade Estadual de Campinas, Department of Surgery - Campinas (SP), Brazil
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16
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Nakao E, Kawamura H, Honda M, Takano Y, Kinuta S, Kamiga T, Yamazaki S, Muto A, Shiraso S, Yamashita N, Iwao T, Kono K, Konno S. Prognostic impact and survival outcomes of colon perforation in patients with metastatic colorectal cancer: a multicenter retrospective cohort study. Int J Clin Oncol 2024; 29:179-187. [PMID: 38078975 DOI: 10.1007/s10147-023-02444-5] [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] [Accepted: 11/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Colon perforation caused by colorectal cancer (CRC) is a fatal condition requiring emergency intervention. For patients with metastatic lesions, surgeons face difficult decisions regarding whether to resect the primary and metastatic lesions. Moreover, there is currently no established treatment strategy for these patients. This study aimed to investigate the clinical practice and long-term outcomes of patients with metastatic CRC diagnosed with the onset of colon perforation. METHODS We performed a population-based multicenter cohort study. Consecutive patients diagnosed with stage IV CRC between 2008 and 2015 at all designated cancer hospitals in Fukushima Prefecture, Japan, were enrolled in this study. We evaluated the impact of colon perforation on the survival outcomes of patients with metastatic CRC. The main outcome was the adjusted hazard ratio (aHR) of perforation for overall survival (OS). Survival time and HRs were estimated using Kaplan‒Meier and Cox proportional regression analyses. RESULTS A total of 1258 patients were enrolled (perforation: n = 46; non-perforation: n = 1212). All but one of the patients with perforation underwent primary resection or colostomy and 25 cases were able to receive chemotherapy. The median OS for the perforation and non-perforation groups was 19.0 and 20.0 months, respectively (p = 0.96). Moreover, perforation was not an independent prognostic factor (aHR: 0.99; 95% confidence interval: 0.61-1.28). CONCLUSIONS In metastatic CRC, perforation is not necessarily a poor prognostic factor. Patients with perforation who undergo primary tumor resection or colostomy and prompt initiation of systemic chemotherapy might be expected to have a survival time similar to that of patients with non-perforated colon.
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Affiliation(s)
- Eiichi Nakao
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan.
- Department of Surgery, Southern TOHOKU General Hospital, 7-115 Yatsuyamada Koriyama-shi, Koriyama, Fukushima, 963-8563, Japan.
| | - Hidetaka Kawamura
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern TOHOKU General Hospital, 7-115 Yatsuyamada Koriyama-shi, Koriyama, Fukushima, 963-8563, Japan
| | - Shunji Kinuta
- Department of Surgery, The Takeda Healthcare Foundation Takeda General Hospital, Aizu Wakamatsu, -27 Yamagamachi Aizuwakamatsu-shi, Fukushima, Fukushima, 965-8585, Japan
| | - Takahiro Kamiga
- Department of Surgery, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro Shirakawa-shi, Shirakawa, Fukushima, 961-0005, Japan
| | - Shigeru Yamazaki
- Department of Surgery, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi Koriyama-shi, Koriyama, Fukushima, 963-8558, Japan
| | - Atsushi Muto
- Department of Surgery, Fukushima Rosai Hospital, 3 Uchigotsuzuramachi Numajiri Iwaki-shi, Iwaki, Fukushima, 973-8403, Japan
| | - Satoru Shiraso
- Department of Surgery, Iwaki Kyoritsu General Hospital, 16 Uchigomimayamachi Kuzehara Iwaki-shi, Iwaki, Fukushima, 973-8555, Japan
| | - Naoyuki Yamashita
- Department of Surgery, Tsuboi Hospital, 1-10-13 Asakamachi Nagakubo Koriyama-shi, Koriyama, Fukushima, 963-0105, Japan
| | - Toshiyasu Iwao
- Department of Gastroenterology, Aizu Chuo Hospital, 1-1 Tsurugacho Aizuwakamatsu-shi, Aizu Wakamatsu, Fukushima, 965-8611, Japan
| | - Koji Kono
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Shinichi Konno
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
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17
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Giordano A, Podda M, Montori G, Botteri E, Fugazzola P, Ortenzi M, Guerrieri M, Vettoretto N, Agresta F, Sartori A, Bergamini C, Martellucci J, Guariniello A, Fransvea P, Azzinnaro A, Scatizzi M, Catena F, Coccolini F, Ansaloni L, Sartelli M, Sapienza P, Mingoli A, Prosperi P. Colonic Resection, Stoma, or Self-expanding Metal Stents for Obstructive Left Colon Cancer: the CROSCO-1 study protocol. Minerva Surg 2024; 79:7-14. [PMID: 37705392 DOI: 10.23736/s2724-5691.23.09969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers worldwide. There are several causes of a mechanical left bowel obstructive but CRC accounts for approximately 50% of cases and in 10-30% of whom it is the presenting syndrome. In most cases, the left colon is involved. At present, the range of therapeutic alternatives in the management of obstructive left CRC in emergency conditions (primary resection vs. staged resection with applied self-expanding metallic stents) is broad, whereas internationally validated clinical recommendations in each condition are still lacking. This enormous variability affects the scientific evidence on both the immediate and long-term surgical and oncological outcomes. METHODS CROSCO-1 (Colonic Resection, Stoma or Self-expanding Metal Stents for Obstructive Left Colon Cancer) study is a national, multi-center, prospective observational study intending to compare the clinical results of all these therapeutic regimens in a cohort of patients treated for obstructive left-sided CRC. RESULTS The primary aim of the CROSCO-1 study is the 1-year stoma rate of patients undergoing primary emergency surgical resection (Hartmann procedure or primary resection and anastomosis) compared with patients undergoing staged resection. Secondary outcomes are 30-day and 90-day major morbidity and mortality, 1-year quality of life and the timing of chemotherapy initiation in the two groups. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies. CONCLUSIONS The results of a large prospective cohort study which will analyze what really happens in the common clinical practice of managing patients with obstructive left CRC will have the aim of understanding which is the best strategy in terms of surgical and oncological outcomes. Indeed, the CROSCO-1 study will analyze the early surgical outcomes for patients with obstructed left CRC. Future CROSCO studies will follow in which, instead, we will evaluate the long-term oncological outcomes of the two treatment strategies.
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Affiliation(s)
- Alessio Giordano
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy -
| | - Mauro Podda
- General Surgery Unit, Department of Surgery, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Montori
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Paola Fugazzola
- Division of General Surgery, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Monica Ortenzi
- Department of General Surgery, Polytechnical University of Marche, Ancona, Italy
| | - Mario Guerrieri
- Department of General Surgery, Polytechnical University of Marche, Ancona, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Ferdinando Agresta
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna Hospital, Montebelluna, Treviso, Italy
| | - Carlo Bergamini
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Jacopo Martellucci
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Anna Guariniello
- Emergency Surgery Unit, Department of Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma Department, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Marco Scatizzi
- General Surgery Unit, Department of Surgery, Santa Maria Annunziata and Serristori Hospital, Florence, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Luca Ansaloni
- Division of General Surgery, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Massimo Sartelli
- General Surgery Unit, Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Paolo Sapienza
- Emergency Department, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Andrea Mingoli
- Emergency Department, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Paolo Prosperi
- Emergency Surgery Unit, Emergency Department, Careggi University Hospital, Florence, Italy
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Tonini V, Zanni M. Why is early detection of colon cancer still not possible in 2023? World J Gastroenterol 2024; 30:211-224. [PMID: 38314134 PMCID: PMC10835528 DOI: 10.3748/wjg.v30.i3.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
Colorectal cancer (CRC) screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers. Over the years, screening, particularly in those settings where it is well organized, has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them. Despite considerable advancements in screening technologies and strategies, the effectiveness of CRC screening programs remains less than optimal. This paper examined the multifaceted reasons behind the persistent lack of effectiveness in CRC screening initiatives. Through a critical analysis of current methodologies, technological limitations, patient-related factors, and systemic challenges, we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates. While acknowledging the advancements that have improved aspects of screening, we emphasized the necessity of addressing the identified barriers comprehensively. This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease. Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage. Spending more sooner can mean saving money later.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
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Williams B, Gupta A, Koller SD, Starr TJ, Star MJH, Shaw DD, Hakim AH, Leinicke J, Visenio M, Perrone KH, Torgerson ZH, Person AD, Ternent CA, Chen KA, Kapadia MR, Keller DS, Elnagar J, Okonkwo A, Gagliano RA, Clark CE, Arcomano N, Abcarian AM, Beaty JS. Emergency Colon and Rectal Surgery, What Every Surgeon Needs to Know. Curr Probl Surg 2024; 61:101427. [PMID: 38161059 DOI: 10.1016/j.cpsurg.2023.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Brian Williams
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Abhinav Gupta
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Sarah D Koller
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Tanya Jt Starr
- Health Corporation of America, Midwest Division, Kansas City, KS
| | | | - Darcy D Shaw
- Health Corporation of America, Midwest Division, Kansas City, KS
| | - Ali H Hakim
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer Leinicke
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Michael Visenio
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Kenneth H Perrone
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | | | - Austin D Person
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Charles A Ternent
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Kevin A Chen
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Muneera R Kapadia
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Deborah S Keller
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA; Marks Colorectal Surgical Associates, Wynnewood, PA
| | - Jaafar Elnagar
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA
| | | | | | | | - Nicolas Arcomano
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Ariane M Abcarian
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL; Cook County Health, Chicago, IL
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Liao Y, Ma Y, Chao F, Wang Y, Zhao Z, Ren J. A 37-Year-Old Schizophrenic Woman With Abdominal Pain. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231219076. [PMID: 38106620 PMCID: PMC10725092 DOI: 10.1177/11795476231219076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
Introduction Internal fistula across the posterior wall of stomach and the transverse colon caused by foreign bodies in the alimentary tract presents an extremely rare medical entity. Presentation of case We report an aschizophrenia female patient with onset of internal fistula across the posterior wall of stomach and the transverse colon triggered by swallowed magnetic metal beads. The patient was admitted to the emergency room of Northern Jiangsu People's Hospital because of acute right lower abdominal pain. Emergency routine abdominal CT scan revealed acute appendicitis and a set of foreign body in digestive tract. Discussion The foreign body in the stomach was removed by open surgery after tentative Endoscopic foreign body removal and laparoscopic appendectomy and exploration. In the process of exploring the gastric wall, it was found that one of magnet beads was embedded in the posterior wall of stomach and adhered to part of the transverse colon. After separation, it was found that an internal fistula was formed across the posterior wall of stomach and the transverse colon. As the patient ate only a small amount of food within 2 days, and the intestines were in good condition, we performed partial transverse colectomy, end-to-side anastomosis and gastric wall repair. Conclusion This case shows that for long-term foreign bodies in the digestive tract, we should be beware of the onset of gastrointestinal perforation. Moreover, perforation caused by the force acting on a blunt foreign body often results in atypical imaging findings, and the diagnosis of perforation cannot be clearly determined by imaging findings such as the presence of free gas downstream of the diaphragm. This poses new challenges for clear diagnosis and treatment.
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Affiliation(s)
- Yiqun Liao
- Department of Clinical Medical college, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yue Ma
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Medical School of Nanjing University, Yangzhou, China
| | - Fei Chao
- Department of Anesthesiology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yong Wang
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Ziming Zhao
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Jun Ren
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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21
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Shang R, Han X, Zeng C, Lv F, Fang R, Tian X, Ding X. Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36078. [PMID: 38115371 PMCID: PMC10727616 DOI: 10.1097/md.0000000000036078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The role of self-expanding metal stent (SEMS) implantation as a bridge to surgery in malignant left-sided colorectal obstruction (MLCO) remains controversial. OBJECTIVE To evaluate the safety of SEMS implantation versus emergency surgery (ER) in the treatment of MLCO. METHODS Four major literature databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to collect articles published before April 20, 2023. After determining random or fixed-effect models based on heterogeneity tests, odds ratios (RR) or standardized mean differences (SMD) with their respective 95% confidence intervals (CI) were calculated. RESULTS Nineteen randomized controlled studies were included. The main outcomes included overall tumor recurrence rate, 30-day mortality rate, and overall incidence of complications. Secondary outcomes included mortality-related indicators, tumor recurrence-related indicators, surgery-related indicators, and other relevant indicators. The study found that there was no significant difference in the 30-day mortality rate between the SEMS group and the er group. However, the SEMS group had a lower overall incidence of complications (RR = 0.787, P = .004), lower incision infection rate (RR = 0.472, P = .003), shorter operation time (SMD = -0.591, P = .000), lower intraoperative blood loss (SMD = -1.046, P = .000), lower intraoperative transfusion rate (RR = 0.624, P = .021), lower permanent stoma rate (RR = 0.499, P = .000), lower overall stoma rate (RR = 0.520,P = .000), shorter hospital stay (SMD = -0.643, P = .014), and more lymph node dissections during surgery (SMD = 0.222, 95% CI: 0.021-0.423, P = .031), as well as a higher primary anastomosis rate (RR = 0.472, 95% CI: 0.286-0.7 77, P = .003), among other advantages. However, the SEMS group had a higher overall tumor recurrence rate (RR = 1.339, P = .048). CONCLUSION SEMS has significant advantages over er in relieving clinical symptoms and facilitating postoperative recovery in MLCO, but does not reduce the tumor recurrence rate. Neoadjuvant chemotherapy combined with SEMS may provide a new approach to the treatment of MLCO.
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Affiliation(s)
- Rumin Shang
- Department of Gastroenterology, Wuhan Pu’ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangming Han
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cui Zeng
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Fei Lv
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Rong Fang
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiaochang Tian
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
| | - Xiangwu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, China
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22
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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McKechnie T, Tessier L, Archer V, Park L, Cohen D, Levac B, Parpia S, Bhandari M, Dionne J, Eskicioglu C. Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02387-6. [PMID: 37985500 DOI: 10.1007/s00068-023-02387-6] [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: 06/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to evaluate whether Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing emergency intra-abdominal surgery improve postoperative outcomes as compared to conventional care. METHODS MEDLINE, EMBASE, WoS, CENTRAL, and Pubmed were searched from inception to December 2022. Articles were eligible if they were randomized controlled trials (RCT) or non-randomized studies comparing ERAS protocols to conventional care for patients undergoing emergency intra-abdominal surgery. The outcomes included postoperative length of stay (LOS), postoperative morbidity, prolonged postoperative ileus (PPOI), and readmission. An inverse variance random effects meta-analysis was performed. A risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. RESULTS After screening 1018 citations, 20 studies with 1615 patients in ERAS programs and 1933 patients receiving conventional care were included. There was a reduction in postoperative LOS in the ERAS group for patients undergoing upper gastrointestinal (GI) surgery (MD3.35, 95% CI 2.52-4.17, p < 0.00001) and lower GI surgery (MD2.80, 95% CI 2.62-2.99, p < 0.00001). There was a reduction in postoperative morbidity in the ERAS group for patients undergoing upper GI surgery (RR0.56, 95% CI 0.30-1.02, p = 0.06) and lower GI surgery (RR 0.66, 95%CI 0.52-0.85, p = 0.001). In the upper and lower GI subgroup, there were nonsignificant reductions in PPOI in the ERAS groups (RR0.59, 95% CI 0.30-1.17, p = 0.13; RR0.49, 95% CI 0.21-1.14, p = 0.10). There was a nonsignificant increased risk of readmission in the ERAS group (RR1.60, 95% CI 0.57-4.50, p = 0.50). CONCLUSION There is low-to-very-low certainty evidence supporting the use ERAS protocols for patients undergoing emergency intra-abdominal surgery. The currently available data are limited by imprecision.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Léa Tessier
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Victoria Archer
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brendan Levac
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Joanna Dionne
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada.
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24
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Watanabe J, Sasabuchi Y, Ohbe H, Nakajima M, Matsui H, Miki A, Horie H, Kotani K, Yasunaga H, Sata N. Impact of Preoperative Stoma Site Marking on Morbidity and Mortality in Patients with Colorectal Perforation: A Nationwide Retrospective Cohort Study. World J Surg 2023; 47:2857-2864. [PMID: 37301796 DOI: 10.1007/s00268-023-07090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Preoperative stoma site marking reduces the incidence of complications from elective surgery. However, the impact of stoma site marking in emergency patients with colorectal perforation remains unclear. This study aimed to assess the impact of stoma site marking on morbidity and mortality in patients with colorectal perforation who underwent emergency surgery. METHODS This retrospective cohort study used the Japanese Diagnosis Procedure Combination inpatient database from April 1, 2012, to March 31, 2020. We identified patients who underwent emergency surgery for colorectal perforation. We compared outcomes between those with and without stoma site marking using propensity score matching to adjust for confounding factors. The primary outcome was the overall complication rate, and the secondary outcomes were stoma-related, surgical, and medical complications and 30-day mortality. RESULTS We identified 21,153 patients (682 with stoma site marking and 20,471 without stoma site marking) and grouped them into 682 pairs using propensity score matching. The overall complication rates were 23.5% and 21.4% in the groups with and without stoma site marking, respectively (p = 0.40). Stoma site marking was not associated with a decrease in stoma-related, surgical, or medical complications. The 30-day mortality did not differ significantly between the groups with and without stoma site marking (7.9% vs. 8.4%, p = 0.843). CONCLUSIONS Preoperative stoma site marking was not associated with a reduction in morbidity and mortality in patients with colorectal perforation who underwent emergency surgery.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Tokyo, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan
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Cairl NS, Orelaru F, Golden R. Fournier's Gangrene Secondary to Perforated Sigmoid Adenocarcinoma Within an Incarcerated Inguinal Hernia. Cureus 2023; 15:e49449. [PMID: 38152815 PMCID: PMC10751226 DOI: 10.7759/cureus.49449] [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: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
Colon cancer is the third most common cancer worldwide. Approximately one-fifth of colon cancers will present emergently due to obstruction or perforation. Necrotizing soft tissue infection is a rare presentation of perforated colon cancer and represents a surgical emergency due to high mortality rate. A man in his 80s presented with several days of scrotal pain and weakness. On physical exam he was found to have scrotal edema and erythema and bilateral inguinal hernias. Imaging revealed a large scrotal abscess and concern for necrotizing soft tissue infection. He was taken to the operating room for surgical debridement and exploration and was discovered to have perforated colon within an incarcerated inguinal hernia. He underwent exploratory laparotomy with sigmoid resection and end colostomy creation. Pathology returned demonstrating invasive sigmoid adenocarcinoma. Fournier's gangrene requires a high index of suspicion. It is a rapidly progressing infection associated with high mortality. Early initiation of antibiotics and surgical debridement are mainstays of treatment. When associated with perforated colonic malignancy, workup must include imaging of the chest, abdomen, and pelvis as well as carcinoembryonic antigen (CEA) level to complete staging. Fournier's gangrene secondary to perforated sigmoid adenocarcinoma is a unique presentation. Treatment first involves antibiotics and aggressive surgical debridement. Once the patient is stabilized, further oncologic workup should be completed to determine treatment course.
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Affiliation(s)
| | - Felix Orelaru
- General Surgery, Trinity Health Ann Arbor, Ann Arbor, USA
| | - Roy Golden
- Trauma, Acute and Critical Care Surgery, Trinity Health Ann Arbor, Ann Arbor, USA
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Chang J, Assouline E, Calugaru K, Gajic ZZ, Doğru V, Ray JJ, Erkan A, Esen E, Grieco M, Remzi F. Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP. Tech Coloproctol 2023; 27:1065-1071. [PMID: 37642739 DOI: 10.1007/s10151-023-02852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis. RESULTS We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001). CONCLUSIONS This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.
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Affiliation(s)
- J Chang
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, 10016, USA
| | - E Assouline
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, 10016, USA
| | - K Calugaru
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, 10016, USA
| | - Z Z Gajic
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, 10016, USA
| | - V Doğru
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA
| | - J J Ray
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA
| | - A Erkan
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA
| | - E Esen
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA
| | - M Grieco
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA
| | - F Remzi
- NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA.
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Boeding JRE, Elferink MAG, Tanis PJ, de Wilt JHW, Gobardhan PD, Verhoef C, Schreinemakers JMJ. Surgical treatment and overall survival in patients with right-sided obstructing colon cancer-a nationwide retrospective cohort study. Int J Colorectal Dis 2023; 38:248. [PMID: 37796315 PMCID: PMC10556181 DOI: 10.1007/s00384-023-04541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this study was to compare baseline characteristics, 90-day mortality and overall survival (OS) between patients with obstructing and non-obstructing right-sided colon cancer at a national level. METHODS All patients who underwent resection for right-sided colon cancer between January 2015 and December 2016 were selected from the Netherlands Cancer Registry and stratified for obstruction. Primary outcome was 5-year OS after excluding 90-day mortality as assessed by the Kaplan-Meier and multivariable Cox regression analysis. RESULTS A total of 525 patients (7%) with obstructing and 6891 patients (93%) with non-obstructing right-sided colon cancer were included. Patients with right-sided obstructing colon cancer (OCC) were older and had more often transverse tumour location, and the pathological T and N stage was more advanced than in those without obstruction (p < 0.001). The 90-day mortality in patients with right-sided OCC was higher compared to that in patients with non-obstructing colon cancer: 10% versus 3%, respectively (p < 0.001). The 5-year OS of those surviving 90 days postoperatively was 42% in patients with OCC versus 73% in patients with non-obstructing colon cancer, respectively (p < 0.001). Worse 5-year OS was found in patients with right-sided OCC for all stages. Obstruction was an independent risk factor for decreased OS in right-sided colon cancer (HR 1.79, 95% CI 1.57-2.03). CONCLUSION In addition to increased risk of postoperative mortality, a stage-independent worse 5-year OS after excluding 90-day mortality was found in patients with right-sided OCC compared to patients without obstruction.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Marloes A G Elferink
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. PATIENT EDUCATION AND COUNSELING 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Ma W, Zhang JC, Luo K, Wang L, Zhang C, Cai B, Jiang H. Self-expanding metal stents versus decompression tubes as a bridge to surgery for patients with obstruction caused by colorectal cancer: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:46. [PMID: 37759264 PMCID: PMC10536785 DOI: 10.1186/s13017-023-00515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Using self-expanding metal stents (SEMS) and decompression tubes (DT) as a bridge-to-surgery (BTS) treatment may avoid emergency operations for patients with colorectal cancer-caused obstructions. This study aimed to evaluate the efficacy and safety of the two approaches. METHODS We systematically retrieved literature from January 1, 2000, to May 30, 2023, from the PubMed, Embase, Web of Science, SinoMed, Wanfang Data, Chinese National Knowledge Infrastructure, and Cochrane Central Register of Clinical Trials databases. Randomized controlled trials (RCTs) or cohort studies of SEMS versus DT as BTS in colorectal cancer obstruction were selected. Risks of bias were assessed for RCTs and cohort studies using the Cochrane Risk of Bias tool version 2 and Risk of Bias in Nonrandomized Studies of Interventions. Certainty of evidence was determined using the Graded Recommendation Assessment. Odds ratio (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data. RESULTS We included eight RCTs and eighteen cohort studies involving 2,061 patients (SEMS, 1,044; DT, 1,017). Pooled RCT and cohort data indicated the SEMS group had a significantly higher clinical success rate than the DT group (OR = 1.99, 95% CI 1.04, 3.81, P = 0.04), but no significant difference regarding technical success (OR = 1.29, 95% CI 0.56, 2.96, P = 0.55). SEMS had a shorter postoperative length of hospital stays (MD = - 4.47, 95% CI - 6.26, - 2.69, P < 0.00001), a lower rates of operation-related abdominal pain (OR = 0.16, 95% CI 0.05, 0.50, P = 0.002), intraoperative bleeding (MD = - 37.67, 95% CI - 62.73, - 12.60, P = 0.003), stoma creation (OR = 0.41, 95% CI 0.23, 0.73, P = 0.002) and long-term tumor recurrence rate than DT (OR = 0.47, 95% CI 0.22, 0.99, P = 0.05). CONCLUSION SEMS and DT are both safe as BTS to avoid emergency surgery for patients with colorectal cancer obstruction. SEMS is preferable because of higher clinical success rates, lower rates of operation-related abdominal pain, intraoperative bleeding, stoma creation, and long-term tumor recurrence, as well as a shorter postoperative length of hospital stays. Trial registration CRD42022365951 .
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Affiliation(s)
- Wei Ma
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Jian-Cheng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Kun Luo
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Chi Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Bin Cai
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China.
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, China.
- Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness. Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Kim DH, Lee KH. Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study. Front Surg 2023; 10:1243125. [PMID: 37829597 PMCID: PMC10566360 DOI: 10.3389/fsurg.2023.1243125] [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: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. Methods We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Results Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Conclusion Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.
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Affiliation(s)
| | - Kyung-Ha Lee
- Department of Colorectal Surgery, Chungnam National University College of Medicine and Hospital, Daejeon, Republic of Korea
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31
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Boeding JRE, Cuperus IE, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. Postponing surgery to optimise patients with acute right-sided obstructing colon cancer - A pilot study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106906. [PMID: 37061403 DOI: 10.1016/j.ejso.2023.04.005] [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: 09/20/2022] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Right-sided obstructing colon cancer is most often treated with acute resection. Recent studies on right-sided obstructing colon cancer report higher mortality and morbidity rates than those in patients without obstruction. The aim of this study is to retrospectively analyse whether it is possible to optimise the health condition of patients with acute right-sided obstructing colon cancer, prior to surgery, and whether this improves postoperative outcomes. METHOD All consecutive patients with high suspicion of, or histologically proven, right-sided obstructing colon cancer, treated with curative intent between March 2013 and December 2019, were analysed retrospectively. Patients were divided into two groups: optimised group and non-optimised group. Pre-operative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. RESULTS In total, 54 patients were analysed in this study. Twenty-four patients received optimisation before elective surgery, and thirty patients received emergency surgery, without optimisation. Scheduled surgery was performed after a median of eight days (IQR 7-12). Postoperative complications were found in twelve (50%) patients in the optimised group, compared to twenty-three (77%) patients in the non-optimised group (p = 0.051). Major complications were diagnosed in three (13%) patients with optimisation, compared to ten (33%) patients without optimisation (p = 0.111). Postoperative in-hospital stay, 30-day mortality, as well as primary anastomosis were comparable in both groups. CONCLUSION This pilot study suggests that pre-operative optimisation of patients with obstructing right sided colonic cancer may be feasible and safe but is associated with longer in-patient stay.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Iris E Cuperus
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Yu DF, Yang L, Wang C, Zhou ZG. Intraoperative two-way versus one-way irrigation in patients with obstructed left-sided colorectal cancer: A retrospective study. Asian J Surg 2023; 46:3856-3857. [PMID: 37031084 DOI: 10.1016/j.asjsur.2023.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Deng-Feng Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of General Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Cun Wang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
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Coccolini F, Mazzoni A, Cremonini C, Cobuccio L, Pucciarelli M, Vetere G, Borelli B, Strambi S, Musetti S, Miccoli M, Cremolini C, Tartaglia D, Chiarugi M. Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial). Updates Surg 2023; 75:1579-1587. [PMID: 37160552 PMCID: PMC10435586 DOI: 10.1007/s13304-023-01521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
| | - Alessio Mazzoni
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Luigi Cobuccio
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marsia Pucciarelli
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | | | | | - Silvia Strambi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Serena Musetti
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Mario Miccoli
- Statistical Department, Pisa University, Pisa, Italy
| | | | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Turgunov Y, Ogizbayeva A, Shakeyev K, Mugazov M, Akhmaltdinova L, Nuraly S, Rudolf V. The dynamics of the lipopolysaccharide-binding protein (LBP) level in assessing the risk of adverse outcomes in operated colorectal cancer patients. Asian J Surg 2023:S1015-9584(23)01268-X. [PMID: 37652762 DOI: 10.1016/j.asjsur.2023.08.101] [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: 03/16/2023] [Revised: 06/13/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The main aim of this study is to analyze changes in the lipopolysaccharide-binding protein (LBP) level in blood serum over time and assess it as a potential risk factor for the development of SIRS, infectious and inflammatory complications, organ dysfunction and mortality in patients operated on colorectal cancer (CRC). METHODS 90 CRC patients were divided into 2 groups: Group 1-50 patients operated on for CRC without acute bowel obstruction (ABO); Group 2-40 patients operated on for CRC with ABO. To determine LBP by ELISA method venous blood was taken 1 h before surgery and 72 h after it (3rd day). RESULTS LBP level on the 3rd day after surgery was lower in CRC patients with SIRS, postoperative complications, organ dysfunction and in dead patients. With an LBP value on the 3rd day after surgery being at ≤821.95 ng/mL, the risk of SIRS occurrence is 3.5 times higher, that of the postoperative complications is 5.2 times higher and death is 12.9 times higher than with its higher level (OR 3.5, CI 1.46-8.4; OR 5.2, CI 1.80-15.12; OR 12.9, CI 1.54-108.21, respectively). If the LBP value on the 3rd day after surgery is ≤ 700.15 ng/mL, the risk of organ dysfunctions is 13.5 times higher than with its higher level (OR 13.5, CI 3.536-51.54). CONCLUSIONS This study demonstrated that in the patients with CRC, the LBP can be used as a predictive criterion for the development of SIRS, postoperative infectious and inflammatory complications, organ dysfunction, and mortality.
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Affiliation(s)
- Yermek Turgunov
- Department of Surgical Diseases, NJSC "Karaganda Medical University", Karaganda, Kazakhstan
| | - Alina Ogizbayeva
- Department of Emergency Medical Care, Anesthesiology and Resuscitation, NJSC "Karaganda Medical University", Karaganda, Kazakhstan.
| | - Kayrat Shakeyev
- Department of Surgical Diseases, NJSC "Karaganda Medical University", Karaganda, Kazakhstan
| | - Miras Mugazov
- Department of Emergency Medical Care, Anesthesiology and Resuscitation, NJSC "Karaganda Medical University", Karaganda, Kazakhstan
| | | | - Shynggys Nuraly
- Department of Surgical Diseases, NJSC "Karaganda Medical University", Karaganda, Kazakhstan
| | - Viktor Rudolf
- Department of Emergency Medical Care, Anesthesiology and Resuscitation, NJSC "Karaganda Medical University", Karaganda, Kazakhstan
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Secher J, Balachandran R, Iversen LH. Incidence and risk factors of blowout within 90 days after a primary Hartmann's procedure: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:275. [PMID: 37442862 PMCID: PMC10345077 DOI: 10.1007/s00423-023-02967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The literature reports a varying occurrence (3-33%) of blowout of the rectal remnant after Hartmann's procedure, and there is a lack of multivariate analyses on potential risk factors for blowout following Hartmann's procedure. We aimed to estimate the incidence of blowout within 90 days after a primary Hartmann's procedure and to identify potential risk factors for blowout through multivariate analysis. METHODS A retrospective cohort study was conducted at the Department of Surgery, Aarhus University Hospital, a Danish primary and tertiary hospital. Patients who underwent primary surgery with Hartmann's procedure irrespective of surgical setting and indications between September 2016 and August 2021 were included. Blowout was defined as a defective closure line of the rectal stump or a pelvic abscess. RESULTS A total of 178 patients were included, and blowout occurred in 30 patients (16.9%) within 90 days after a primary Hartmann's procedure. Multivariate analysis showed increased risk of blowout among patients with Hinchey IV diverticulitis (relative risk 6.32 (95% CI 4.09-9.75)), previous radiotherapy (relative risk 3.35 (95% CI 1.67-6.74)), and alcohol overconsumption (relative risk 1.69 (95% CI 1.05-2.72)). Intraoperative insertion of a Foley catheter in the rectal remnant significantly reduced the risk of blowout within 90 days after a primary Hartmann's procedure (relative risk 0.18 (95% CI 0.05-0.65)). CONCLUSION Blowout remains a severe and common complication within 90 days after a primary Hartmann's procedure. Hinchey IV diverticulitis, pelvic radiotherapy, and alcohol overconsumption are risk factors. An intraoperatively inserted rectal Foley catheter is a protective factor and can be considered used in all patients undergoing Hartmann's procedure.
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Affiliation(s)
- Josefine Secher
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
| | - Rogini Balachandran
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Hjerrild Iversen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Mäder M, Kalt F, Schneider M, Kron P, Ramser M, Lopez-Lopez V, Biondo S, Faucheron JL, Yoshiyuki S, von der Groeben M, Novak A, Teufelberger G, Lehmann K, Eshmuminov D. Self-expandable metallic stent as bridge to surgery vs. emergency resection in obstructive right-sided colon cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:265. [PMID: 37402932 DOI: 10.1007/s00423-023-02979-1] [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: 02/06/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Emergency resection is common for malignant right-sided obstructive colon cancer. As there is evidence showing a potential benefit of self-expandable metal stents as a bridge to surgery, a new debate has been initiated. OBJECTIVE The aim of this study was to compare self-expandable metal stents with emergency resection in right-sided obstructive colon cancer. DATA SOURCE A systematic search was conducted accessing Medline/PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews. STUDY SELECTION Studies reporting either emergency surgery or stent placement in right-sided obstructive colon cancer were included. INTERVENTION Stent or emergency resection in right-sided obstructive colon cancer. MAIN OUTCOME MEASURES Morbidity rate, mortality rate, stoma rate, laparoscopic resection rate, anastomotic insufficiency rate, success rate of stent. RESULTS A total of 6343 patients from 16 publications were analyzed. The stent success rate was 0.92 (95% CI, 0.87 to 0.95) with perforation of 0.03 (95% CI, 0.01 to 0.06). Emergency resection was performed laparoscopically at a rate of 0.15 (95% CI, 0.09 to 0.24). Primary anastomosis rate in emergency resection was 0.95 (95% CI, 0.91 to 0.97) with an anastomotic insufficiency rate of 0.07 (95% CI, 0.04 to 0.11). The mortality rate after emergency resection was 0.05 (95% CI, 0.02 to 0.09). Primary anastomosis and anastomotic insufficiency rate were similar between the two groups (RR: 1.02; 95% CI, 0.95 to 1.1; p = 0.56 and RR: 0.53; 95% CI, 0.14 to 1.93; p = 0.33). The mortality rate in emergency resection was higher compared to stent (RR: 0.51, 95% CI 0.30 to 10.89, p = 0.016). LIMITATION No randomized controlled trials are available. CONCLUSION Stent is a safe and successful alternative to emergency resection and may increase the rate of minimally invasive surgery. Emergency resection, however, remains safe and did not result in higher rate of anastomotic insufficiency. Further high-quality comparative studies are warranted to assess long-term outcomes.
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Affiliation(s)
- Mirjam Mäder
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | - Fabian Kalt
- Department of General Surgery, Hospital Muri, Muri, Switzerland
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marcel Schneider
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Kron
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Ramser
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Victor Lopez-Lopez
- Department of Surgery and Transplantation, IMIB-Arrixaca, Virgen de La Arrixaca Clinic and University, Murcia, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Jean-Luc Faucheron
- Department of Surgery, Grenoble Alps University Hospital, Grenoble, France
| | - Suzuki Yoshiyuki
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | | | - Allan Novak
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | | | - Kuno Lehmann
- Department of General Surgery, Hospital Muri, Muri, Switzerland
| | - Dilmurodjon Eshmuminov
- Department of General Surgery, Hospital Muri, Muri, Switzerland.
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Agger E, Bjartling C, Vedin T. Cervical myoma causing colonic obstruction in the first trimester of pregnancy - a case report. Case Rep Womens Health 2023; 38:e00506. [PMID: 37113654 PMCID: PMC10127115 DOI: 10.1016/j.crwh.2023.e00506] [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: 03/28/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
A 39-year-old nulliparous woman with a previously known cervical myoma was admitted to the obstetrics department during the first trimester with complaints of severe abdominal pain, lack of bowel movements and the suspicion of a clinical bowel obstruction. Because no literature on this exact condition could be found, clinical decisions were based on reports and practice in similar situations. Ultrasound revealed the progression of a cervical myoma (previously 9 cm across), now 12 × 12 × 11 cm in size and a distended large bowel. Sigmoidoscopy excluded intraluminal obstruction. The patient was treated with oral laxatives and enema without success and her condition deteriorated. The myomatous cervix was examined vaginally (bimanual manoeuvre) with the patient under anaesthesia; however, attempts to dislodge the obstruction proved unsuccessful. After surgical consultation the patient was planned for an emergency laparoscopic sigmoidostomy. The post-operative course was uneventful and the patient discharged. She delivered a healthy child with caesarean section in gestation week 36. Bowel continuity was later laparoscopically restored in conjunction with a hysterectomy. This case illustrates the importance of active multidisciplinary management in a case of severe colonic obstruction caused by pregnancy-related obstruction in the small pelvis. In this case, colonic perforation and abortion of the fetus were both avoided.
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Affiliation(s)
- Erik Agger
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
- Corresponding author at: Department of Surgery, Skåne University Hospital, SE-214 28, Malmö, Sweden.
| | - Carina Bjartling
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Tomas Vedin
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
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Boeding JRE, Gobardhan PD, Rijken AM, Seerden TCJ, Verhoef C, Schreinemakers JMJ. Preoptimisation in patients with acute obstructive colon cancer (PREOCC) - a prospective registration study protocol. BMC Gastroenterol 2023; 23:186. [PMID: 37231376 DOI: 10.1186/s12876-023-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Postoperative mortality and morbidity rates are high in patients with obstructing colon cancer (OCC). Different treatment options have been evaluated over the years, mainly for left sided OCC. Optimising the preoperative health condition in elective colorectal cancer (CRC) treatment shows promising results. The aim of this study is to determine whether preoptimisation is feasible in patients with OCC, with a special interest/focus on right-sided OCC, and if, ultimately, optimisation reduces mortality and morbidity (stoma rates, major and minor complications) rates in OCC. METHODS This is a prospective registration study including all patients presenting with OCC in our hospital. Patients with OCC, treated with curative intent, will be screened for eligibility to receive preoptimisation before surgery. The preoptimisation protocol includes; decompression of the small bowel with a NG-tube for right sided obstruction and SEMS or decompressing ileostomy or colostomy, proximal to the site of obstruction, for left sided colonic obstructions. For the additional work-up, additional nutrition by means of parenteral feeding (for patients who are dependent on a NG tube) or oral/enteral nutrition (in case the obstruction is relieved) is provided. Physiotherapy with attention to both cardio and muscle training prior surgical resection is provided. The primary endpoint is complication-free survival (CFS) at the 90 day period after hospitalisation. Secondary outcomes include pre- and postoperative complications, patient- and tumour characteristics, surgical procedures, total in hospital stay, creation of decompressing and/or permanent ileo- or colostomy and long-term (oncological) outcomes. DISCUSSION Preoptimisation is expected to improve the preoperative health condition of patients and thereby reduce postoperative complications. TRIAL REGISTRATION Trial Registry: NL8266 date of registration: 06-jan-2020. STUDY STATUS Open for inclusion.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology, Amphia Hospital, Breda, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Russo S, Conigliaro R, Coppini F, Dell'Aquila E, Grande G, Pigò F, Mangiafico S, Lupo M, Marocchi M, Bertani H, Cocca S. Acute left-sided malignant colonic obstruction: Is there a role for endoscopic stenting? World J Clin Oncol 2023; 14:190-197. [PMID: 37275939 PMCID: PMC10236983 DOI: 10.5306/wjco.v14.i5.190] [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: 09/18/2022] [Revised: 11/23/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
The therapy of left-sided malignant colonic obstruction continues to be one of the largest problems in clinical practice. Numerous studies on colonic stenting for neoplastic colonic obstruction have been reported in the last decades. Thereby the role of self-expandable metal stents (SEMS) in the treatment of malignant colonic obstruction has become better defined. However, numerous prospective and retrospective investigations have highlighted serious concerns about a possible worse outcome after endoscopic colorectal stenting as a bridge to surgery, particularly in case of perforation. This review analyzes the most recent evidence in order to highlight pros and cons of SEMS placement in left-sided malignant colonic obstruction.
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Affiliation(s)
- Salvatore Russo
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Francesca Coppini
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, IRCCs di Reggio Emilia, Reggio Emilia 42122, Italy
| | - Emanuela Dell'Aquila
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome 0144, Italy
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Marinella Lupo
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Margherita Marocchi
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Silvia Cocca
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
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Paniagua García-Señoráns M, Sánchez Santos R, Cano Valderrama Ó, Vigorita V, de Castro Parga ML, Cea Pereira S, Rodríguez Fernández L, Moncada Iribarren E. Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol. Surg Endosc 2023:10.1007/s00464-023-10091-0. [PMID: 37198409 DOI: 10.1007/s00464-023-10091-0] [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: 01/08/2023] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Even if the use of stent as bridge to surgery (BTS) for obstructive colon cancer was described long ago, there is still much controversy on their use. Patient recovery before surgery and colonic desobstruction are just some of the reasons to defend this management that can be found in several available articles. METHODS This is a single-center, retrospective cohort study, including patients with obstructive colon cancer treated between 2010 and 2020. The primary aim of this study is to compare medium-term oncological outcomes (overall survival, disease-free survival) between stent as BTS and ES groups. The secondary aims are to compare perioperative results (in terms of approach, morbidity and mortality, and rate of anastomosis/stomas) between both groups and, within the BTS group, analyze whether there are any factors that may influence oncological outcomes. RESULTS A total of 251 patients were included. Patients belonging to the BTS cohort presented a higher rate of laparoscopic approach, required less intensive care management, less reintervention, and less permanent stoma rate, when comparing with patients who underwent urgent surgery (US). There were not significant differences in terms of disease-free survival and overall survival between the two groups. Lymphovascular invasion negatively affected oncological results but was not related with stent placement. CONCLUSION The stent as a bridge to surgery is a good alternative to urgent surgery, which leads to a decrease in postoperative morbidity and mortality without significantly worsening oncological outcomes.
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Affiliation(s)
- Marta Paniagua García-Señoráns
- Colorrectal Surgery Unit, Álvaro Cunqueiro Hospital, Vigo, Spain.
- Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36312, Vigo, Spain.
| | | | | | | | | | - Sonia Cea Pereira
- Interventional Radiology Service, Álvaro Cunqueiro Hospital, Vigo, Spain
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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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Feng JY, Wang SF, Yan J. The Application of Enhanced Recovery After Surgery for Gastrectomy and Colorectal Resection: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37130316 DOI: 10.1089/lap.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Purpose: Enhanced recovery after surgery (ERAS) protocols not only positively affect gastrointestinal surgery outcomes but may also increase the risk of some complications. This meta-analysis was conducted to assess the impact of ERAS on the recovery and complications following gastrointestinal surgery. Materials and Methods: Studies published before December 2022 were retrieved from the following databases, EMBASE, PubMed, Cochrane Library, and Web of Science, without limitations of language or race. The endpoints included lung infection, surgical site infection, postoperative ileus, length of hospitalization, urinary tract infection, readmission, anastomotic leakage, and C-reactive protein serum levels. Results: A total of 23 studies were included. The results of the meta-analysis revealed that there was a decrease in incidence of the lung infection (risk ratio = 0.46, 95% confidence interval 0.27-0.74, P = .002) and postoperative length of hospitalization (P < .00001). However, ERAS protocol groups had higher readmission rates, nausea, and vomiting. There was no significant difference in the incidence of anastomotic leakage, ileus, surgical site infection, and urinary tract infection between the experimental and control groups. Conclusions: ERAS protocols can reduce the risk of postoperative lung infections, shorten hospital stays, and expedite patient recovery. Furthermore, ERAS protocols are not associated with serious complications following gastrointestinal surgeries.
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Affiliation(s)
- Jia-Ying Feng
- Department of Medicine, Yangtze University, Jingzhou, China
| | - Su-Fei Wang
- Gynaecology and Obstetrics, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Jing Yan
- Department of Medicine, Yangtze University, Jingzhou, China
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Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis. Surg Endosc 2023:10.1007/s00464-023-09929-4. [PMID: 36869265 PMCID: PMC9984133 DOI: 10.1007/s00464-023-09929-4] [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] [Received: 02/14/2022] [Accepted: 01/28/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Several management options exist for colonic decompression in the setting of malignant large bowel obstruction, including oncologic resection, surgical diversion, and SEMS as a bridge-to-surgery. Consensus has yet to be reached on optimal treatment pathways. The aim of the present study was to perform a network meta-analysis comparing short-term postoperative morbidity and long-term oncologic outcomes between oncologic resection, surgical diversion, and self-expanding metal stents (SEMS) in left-sided malignant colorectal obstruction with curative intent. METHODS Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared two or more of the following in patients presenting with curative left-sided malignant colorectal obstruction: (1) emergent oncologic resection; (2) surgical diversion; and/or (3) SEMS. The primary outcome was overall 90-day postoperative morbidity. Pairwise meta-analyses were performed with inverse variance random effects. Random-effect Bayesian network meta-analysis was performed. RESULTS From 1277 citations, 53 studies with 9493 patients undergoing urgent oncologic resection, 1273 patients undergoing surgical diversion, and 2548 patients undergoing SEMS were included. Network meta-analysis demonstrated a significant improvement in 90-day postoperative morbidity in patients undergoing SEMS compared to urgent oncologic resection (OR0.34, 95%CrI0.01-0.98). Insufficient RCT data pertaining to overall survival (OS) precluded network meta-analysis. Pairwise meta-analysis demonstrated decreased five-year OS for patients undergoing urgent oncologic resection compared to surgical diversion (OR0.44, 95%CI0.28-0.71, p < 0.01). CONCLUSIONS Bridge-to-surgery interventions may offer short- and long-term benefits compared to urgent oncologic resection for malignant colorectal obstruction and should be increasingly considered in this patient population. Further prospective study comparing surgical diversion and SEMS is needed.
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Molyneux K, Beck-Esmay J, Koyfman A, Long B. High risk and low prevalence diseases: Mesenteric ischemia. Am J Emerg Med 2023; 65:154-161. [PMID: 36638612 DOI: 10.1016/j.ajem.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Mesenteric ischemia is a rare, frequently misdiagnosed, serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mesenteric ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Mesenteric ischemia is an abdominal vascular emergency that includes superior mesenteric arterial embolism, arterial thrombosis, venous mesenteric ischemia, and non-occlusive mesenteric ischemia. It is associated with a variety of risk factors including older age, cardiovascular disease, hypercoagulable state, and end-stage renal disease. The presentation depends on the underlying pathophysiology. While arterial embolic disease may present with sudden, severe pain, the early stages of the disease and other forms can present with vague symptoms, including generalized abdominal pain, weight loss, vomiting, and diarrhea. Laboratory testing can suggest the disease with leukocytosis and elevated lactate, but normal values should not be used to exclude the diagnosis. The imaging modality of choice is triple phase computed tomography with non-contrast, arterial, and delayed phases. The initial ED management includes fluid resuscitation, symptomatic therapy, broad-spectrum antibiotics, and anticoagulation. Emergent consultation with a multidisciplinary team including diagnostic and interventional radiologists and cardiovascular and general surgeons is necessary for definitive treatment. CONCLUSIONS An understanding of mesenteric ischemia can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Kevin Molyneux
- Department of Emergency Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Jennifer Beck-Esmay
- Department of Emergency Medicine, Mount Sinai Morningside - Mount Sinai West, 1111 Amsterdam Ave, New York, NY 10025, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Bawa D, Khalifa YM, Khan S, Norah W, Noman N. Surgical outcomes and prognostic factors associated with emergency left colonic surgery. Ann Saudi Med 2023; 43:97-104. [PMID: 37031374 PMCID: PMC10082940 DOI: 10.5144/0256-4947.2023.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJECTIVES Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations. DESIGN Retrospective SETTINGS: Three tertiary hospitals in three countries. PATIENTS AND METHODS Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes. MAIN OUTCOME MEASURES 30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients. RESULTS Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status (P=.02), presence of malignancy (P=.02), and the presence of complications (P=.004) were significantly related to mortality in the multivariable logistic regression analysis. CONCLUSIONS The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure. LIMITATIONS The retrospective design and small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Dauda Bawa
- From the Department of Surgery, King Abdullah Hospital Bisha, RIyadh, Saudi Arabia
| | | | - Saleem Khan
- From the Department of Surgery, King Abdullah Hospital Bisha, RIyadh, Saudi Arabia
| | - Waddah Norah
- From the Department of Surgery, Haql General Hospital, Haql, Tabuk, Saudi Arabia
| | - Nibras Noman
- From the Department of Surgery, University of Liverpool, Merseyside, United Kingdom
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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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Yu DF, Yang L, Wang C, Zhou ZG. Intraoperative two-way irrigation versus one-way irrigation in patients with obstructed left-sided colorectal cancer: A retrospective study. Asian J Surg 2023:S1015-9584(22)01818-8. [PMID: 36635173 DOI: 10.1016/j.asjsur.2022.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Deng-Feng Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of General Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Cun Wang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
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Norman J, Moodley Y. Large Bowel Perforation in Patients with Colorectal Cancer: A South African Perspective. JOURNAL OF CANCER & ALLIED SPECIALTIES 2023; 9:517. [PMID: 37196997 PMCID: PMC10187599 DOI: 10.37029/jcas.v9i1.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 05/19/2023]
Abstract
Introduction Large bowel perforation (LBP) occurs in up to 10% of colorectal cancer (CRC) patients and is a potential surgical emergency. Data on LBP in CRC patients from resource-limited countries are required to improve the management of this condition in these settings. Our study aimed to describe LBP amongst CRC patients in KwaZulu-Natal, South Africa. Materials and Methods This was a descriptive sub-analysis of LBP data from an ongoing CRC registry. This study explores free and contained perforations and describes LBP characteristics, surgical management, histological findings, overall survival, and CRC recurrence. Results Ninety-four out of 2523 CRC patients had LBP (3.7%). The median age was 53.0 years (interquartile range: 43.0-64.0). The male-to-female ratio was 1.4:1. Thirty-three patients (35.1%) had a coexisting bowel obstruction. Tumor site perforations occurred in 87 patients (92.6%) and were mostly in the sigmoid colon (36.2%). Perforations were contained in 77 patients (81.9%). Eighty-nine patients (94.7%) underwent resection (elective resection: 76/89 patients, 85.4%). The post-operative inpatient mortality rate was 2.2%. Most patients had Stage III CRC (46 patients, 48.9%) and moderately differentiated tumors (77 patients, 81.9%). Overall survival at 12 months following CRC diagnosis was 55.4%. The early recurrence rate for CRC disease was 5.4%. Conclusion Tumor site perforations predominated, and most were contained. Patients were younger when compared with the international literature. We reaffirm that diastatic-free and contained perforations are two distinct clinical entities.
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Affiliation(s)
- Jocelynn Norman
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Yoshan Moodley
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Correspondence: Yoshan Moodley, Faculty of Medicine and Health Sciences at Stellenbosch University, Francie van Zijl Drive, Parow Cape Town, South Africa 7505. E-mail:
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50
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Zamaray B, van Velzen RA, Snaebjornsson P, Consten ECJ, Tanis PJ, van Westreenen HL. Outcomes of patients with perforated colon cancer: A systematic review. Eur J Surg Oncol 2023; 49:1-8. [PMID: 35995649 DOI: 10.1016/j.ejso.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Perforated colon cancer (PCC) is a distinct clinical entity with implications for treatment and prognosis, however data on PCC seems scarce. The aim of this systematic review is to provide a comprehensive overview of the recent literature on clinical outcomes of PCC. MATERIALS AND METHODS A systematic literature search of MEDLINE (PubMed), Embase, Cochrane library and Google scholar was performed. Studies describing intentionally curative treatment for patients with PCC since 2010 were included. The main outcome measures consisted of short-term surgical complications and long-term oncological outcomes. RESULTS Eleven retrospective cohort studies were included, comprising a total of 2696 PCC patients. In these studies, various entities of PCC were defined. Comparative studies showed that PCC patients as compared to non-PCC patients have an increased risk of 30-day mortality (8-33% vs 3-5%), increased post-operative complications (33-56% vs 22-28%), worse overall survival (36-40% vs 48-65%) and worse disease-free survival (34-43% vs 50-73%). Two studies distinguished free-perforations from contained perforations, revealing that free-perforation is associated with significantly higher 30-day mortality (19-26% vs 0-10%), lower overall survival (24-28% vs 42-64%) and lower disease-free survival (15% vs 53%) as compared to contained perforations. CONCLUSION Data on PCC is scarce, with various PCC entities defined in the studies included. Heterogeneity of the study population, definition of PCC and outcome measures made pooling of the data impossible. In general, perforation, particularly free perforation, seems to be associated with a substantial negative effect on outcomes in colon cancer patients undergoing surgery. Better definition and description of the types of perforation in future studies is essential, as outcomes seem to differ between types of PCC and might require different treatment strategies.
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Affiliation(s)
- B Zamaray
- Department of Surgery, Isala, Zwolle, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands; Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - R A van Velzen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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