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Reynolds IS. An acute care surgeons's dilemma: Operative vs. non-operative management of emergency general surgery conditions in patients with recent colorectal cancer treatment. Am J Surg 2024; 227:13-14. [PMID: 38587049 DOI: 10.1016/j.amjsurg.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 04/09/2024]
Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, 9, Ireland.
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Fico V, Altieri G, Di Grezia M, Bianchi V, Chiarello MM, Pepe G, Tropeano G, Brisinda G. Surgical complications of oncological treatments: A narrative review. World J Gastrointest Surg 2023; 15:1056-1067. [PMID: 37405101 PMCID: PMC10315125 DOI: 10.4240/wjgs.v15.i6.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/03/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.
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Affiliation(s)
- Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | | | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Medicine and Surgery, Catholic School of Medicine, Rome 00168, Italy
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Taqi K, Kim D, Yip L, Laane C, Rana Z, Hameed M, Hamilton T, Stuart H. Emergency surgical consultation for cancer patients: identifying the prognostic determinants of health. World J Surg Oncol 2022; 20:232. [PMID: 35820927 PMCID: PMC9277930 DOI: 10.1186/s12957-022-02694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with malignancy often require urgent surgical consultation for treatment or palliation of disease. The objective of this study is to explore the prognostic determinants affecting care in acute cancer-related surgical presentations and the effect on patient outcomes. MAIN BODY This is a retrospective review of patients referred to the acute general surgery (ACS) service at a tertiary hospital for management of cancer-related problem from July 2017 to September 2018. Patient demographics, course in hospital, and survival were recorded. Multivariant logistic regression and Kaplan-Meier estimates were performed. One hundred eighty-nine patients were identified (53% female) with a mean age of 65.9 years. Forty-two patients (22%) were newly diagnosed with cancer on presentation, and 94 (50%) patients had metastatic disease. Cancer staging was completed in 84% of patients, and 65% had multidisciplinary team (MDT) assessment during their hospital stay. Surgery was performed on 90 (48%) patients, of which 31.2% was with palliative intent. Overall mortality was 56% with 30- and 60-day mortality of 15% and 22%, respectively. The adjusted odds ratio (OR) for a 60-day mortality was high in patients presenting with new cancer diagnosis (OR 3.18, 95% CI 1.18-9.02, p=0.03), metastatic disease (OR 5.11, 95% CI 2.03-12.85, p=0.001), or systemic therapy on presentation (OR 3.46, 95% CI 1.30-9.22, p=0.013). CONCLUSION Emergency surgical referral is common in patients with malignancy. Surgical decision making can be challenging due to the heterogeneity of this population and their associated comorbidities. Optimizing prognostic determinants such as goal-directed palliative care, MDT discussions, and bridging to systemic therapy can improve patient outcomes.
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Affiliation(s)
- Kadhim Taqi
- Department of Surgery - Division of General Surgery, University of British Columbia, 2103, 638 Beach Crescent, Vancouver, BC, V6Z3H4, Canada.
| | - Diane Kim
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lily Yip
- University of British Columbia, Faculty of Medicine, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Charlotte Laane
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Zeeshan Rana
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Morad Hameed
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Trevor Hamilton
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Heather Stuart
- Department of Surgery - Division of General Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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Subtle oncological emergencies: Nature of illness, clinical characteristics, and outcomes. Int Emerg Nurs 2022; 61:101127. [DOI: 10.1016/j.ienj.2021.101127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/27/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
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Alsharawneh A, Maddigan J. The Oncological Emergency of Intestinal Obstruction: ED Recognition and Treatment Outcomes. Semin Oncol Nurs 2021; 37:151207. [PMID: 34462155 DOI: 10.1016/j.soncn.2021.151207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Gastrointestinal complications, like blockage, are among the most common oncological emergencies. We investigated whether individuals with cancer presenting at the emergency department (ED) with intestinal obstruction were triaged accurately, and we further evaluated the triage decisions' effect on their ED treatment outcomes. DATA SOURCES A retrospective review was completed on all available records of adult cancer patients who were admitted with intestinal obstruction to a tertiary referral hospital. Over 3 years, 46 cancer patients were admitted from the ED with a provisional diagnosis of intestinal obstruction, confirmed by radiological examination. More than half the patients were undertriaged, which often resulted in these patients experiencing a series of risky time delays in the ED. Patients were significantly delayed in reaching five treatment outcomes: first assessment with a physician, initiation of treatment, decision to admit, length of ED stay, and length of hospital stay. CONCLUSION The application of triage in practice was inconsistent, inaccurate, and had a significant negative impact on patient treatment outcomes. IMPLICATIONS FOR NURSING PRACTICE The study results indicated the need to critically analyze current triage training and policies to increase their effectiveness. Improvement strategies are identified in the literature, and several are discussed. Involving triage nurses in this work is essential.
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Affiliation(s)
- Anas Alsharawneh
- Assistant Professor, Department of Adult Health Nursing / Faculty of Nursing, Hashemite University, Zarqa, Jordan.
| | - Joy Maddigan
- Associate Professor, Faculty of Nursing, Memorial University, St. John's, NL, Canada
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“-Omas” presenting as “-itis”: acute inflammatory presentations of common gastrointestinal neoplasms. Emerg Radiol 2019; 26:433-448. [DOI: 10.1007/s10140-019-01678-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
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Abou Dagher G, El Khuri C, Chehadeh AAH, Chami A, Bachir R, Zebian D, Bou Chebl R. Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon. BMJ Open 2017; 7:e013502. [PMID: 28289047 PMCID: PMC5353271 DOI: 10.1136/bmjopen-2016-013502] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock. SETTING A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015. PARTICIPANTS 176 patients with cancer were compared with 176 cancer-free controls. PRIMARY AND SECONDARY OUTCOMES The primary outcome of this study was the in hospital mortality in both cohorts. Secondary outcomes included patient demographics, emergency department (ED) vital signs and parameters of resuscitation along with laboratory work. RESULTS A total of 352 patients were analysed. The mean age at presentation for the cancer group was 65.39±15.04 years, whereas the mean age for the control group was 74.68±14.04 years (p<0.001). In the cancer cohort the respiratory system was the most common site of infection (37.5%) followed by the urinary system (26.7%), while in the cancer-free arm, the urinary system was the most common site of infection (40.9%). intravenous fluid replacement for the first 24 hours was higher in the cancer cohort. ED, intensive care unit and general practice unit length of stay were comparable in both the groups. 95 (54%) patients with cancer died compared with 75 (42.6%) in the cancer-free group. The 28-day hospital mortality in the cancer cohort was 87 (49.4%) vs 46 (26.1%) in the cancer-free cohort (p=0.009). Patients with cancer had a 2.320 (CI 95% 1.225 to 4.395, p=0.010) odds of dying compared with patients without cancer in the setting of sepsis. CONCLUSIONS This is the first study looking at an in-depth analysis of sepsis in the specific oncology population. Despite aggressive care, patients with cancer have higher hospital mortality than their cancer-free counterparts while adjusting for all other variables.
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Affiliation(s)
- Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher El Khuri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahel Al-Hajj Chehadeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Chami
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dina Zebian
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Bosscher MRF, Bastiaannet E, van Leeuwen BL, Hoekstra HJ. Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies. Ann Surg Oncol 2015; 23:1803-14. [PMID: 26553441 PMCID: PMC4858551 DOI: 10.1245/s10434-015-4939-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies. METHODS This was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality. RESULTS During the study period, 207 patients experienced surgical oncologic emergencies-101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19-92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002). CONCLUSIONS Defining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.
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Affiliation(s)
- Marianne R F Bosscher
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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