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Yoo RN, Cho HM, Kye BH. Management of obstructive colon cancer: Current status, obstacles, and future directions. World J Gastrointest Oncol 2021; 13:1850-1862. [PMID: 35070029 PMCID: PMC8713324 DOI: 10.4251/wjgo.v13.i12.1850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/07/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Approximately 10%–18% of patients with colon cancer present with obstruction at the initial diagnosis. Despite active screening efforts, the incidence of obstructive colon cancer remains stable. Traditionally, emergency surgery has been indicated to treat patients with obstructive colon cancer. However, compared to patients undergoing elective surgery, the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high. With the advancement of colonoscopic techniques and equipment, a self-expandable metal stent (SEMS) was introduced to relieve obstructive symptoms, allowing the patient’s general condition to be restored and for them undergo elective surgery. As the use of SEMS placement is growing, controversies about its application in potentially curable diseases have been raised. In this review, the short- and long-term outcomes of different treatment strategies, particularly emergency surgery vs SEMS placement followed by elective surgery in resectable, locally advanced obstructive colon cancer, are described based on the location of the obstructive cancer lesion. Controversies regarding each treatment strategy are discussed. To overcome current obstacles, a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.
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Affiliation(s)
- Ri-Na Yoo
- Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 442-723, South Korea
| | - Hyeon-Min Cho
- Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 442-723, South Korea
| | - Bong-Hyeon Kye
- Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 442-723, South Korea
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Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis. BMC Surg 2020; 20:255. [PMID: 33109142 PMCID: PMC7592574 DOI: 10.1186/s12893-020-00908-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. METHODS Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. RESULTS A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = - 3.18, 95% CI - 4.47, - 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = - 0.11, 95% CI - 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. CONCLUSIONS SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.
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Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma. Case Rep Surg 2020; 2020:9371071. [PMID: 31970010 PMCID: PMC6969988 DOI: 10.1155/2020/9371071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/16/2019] [Indexed: 11/30/2022] Open
Abstract
Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.
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Boselli C, Cirocchi R, Gemini A, Grassi V, Avenia S, Polistena A, Sanguinetti A, Burattini MF, Pironi D, Santoro A, Tabola R, Avenia N. Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery. Aging Clin Exp Res 2017; 29:65-71. [PMID: 27837462 DOI: 10.1007/s40520-016-0642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications. MATERIALS AND METHODS We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation. DISCUSSION Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer. CONCLUSIONS The surgical choice should be made case by case (custom-made), not based on age only.
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Affiliation(s)
- Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Andrea Polistena
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Maria Federica Burattini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
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Shwaartz C, Fields AC, Prigoff JG, Aalberg JJ, Divino CM. Should patients With obstructing colorectal cancer have proximal diversion? Am J Surg 2016; 213:742-747. [PMID: 27742029 DOI: 10.1016/j.amjsurg.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Up to 20% of patients with colorectal cancer present with obstruction. The goal of this study was to compare the short-term outcomes of patients with obstructing colon cancer who underwent resection and primary anastomosis with or without proximal diversion. METHODS The American College of Surgeons' National Surgical Quality Improvement Program Procedure Targeted Colectomy databases from 2012 to 2014 were reviewed. Patients undergoing colorectal resection with or without diverting ostomy for obstructing colorectal cancer were analyzed. Propensity score-matched cohorts of diverted and nondiverted patients were created accounting for patient characteristics. The primary outcomes were 30-day mortality, postoperative complications, and readmission. RESULTS There were 2,323 patients (92%) with no proximal diversion and 204 patients (8%) with proximal diversion. In univariate analysis, patients with colorectal resection with diversion were significantly more likely to have any complication (P = .001), sepsis (P = .01), and blood transfusion (P = .001). Diversion patients were also significantly more likely to be readmitted to the hospital within 30 days of the index procedure (P = .02). Proximal diversion was associated with any complication (P = .01), failure to wean off ventilator (P = .05), and longer length of stay (P = .01) in matched cohorts. CONCLUSIONS Proximal diversion in the setting of obstructive colorectal cancer is associated with higher rates of any complication, deep wound infection, sepsis, and readmission. Surgeons who perform a primary anastomosis with diversion for obstructing colorectal cancer should take into account the significant risk for postoperative complications.
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Affiliation(s)
- Chaya Shwaartz
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam C Fields
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jake G Prigoff
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey J Aalberg
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celia M Divino
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Xu SB, Jia Z, Zhu YP, Zhang RC, Wang P. Emergent Laparoscopic Colectomy Is an Effective Alternative to Open Resection for Benign and Malignant Diseases: a Meta-Analysis. Indian J Surg 2016; 79:116-123. [PMID: 28442837 DOI: 10.1007/s12262-015-1436-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/28/2015] [Indexed: 01/06/2023] Open
Abstract
The aim of this study is to compare the perioperative outcomes between laparoscopic and open resections performed for colonic emergencies. A systematic search of the literature identified previously published comparative studies regarding emergent laparoscopic colectomy (ELC) and emergent open colectomy (EOC). Meta-analysis was performed utilizing a pooled odds ratio (OR) for dichotomous variables and a weighted mean difference (WMD) for continuous variables with 95 % confidence intervals (CIs). Eleven studies involving 752 patients were identified. Although operation time was noted to be significantly shorter for EOC, patients post-ELC had significantly lower overall morbidity (OR 0.44; 95 % CI 0.30, 0.66; P < 0.0001). Meanwhile, recovery time for post-ELC patients was significantly shorter, as was the length of hospital stay (WMD -2.78 days; 95 % CI -3.17, -2.38; P < 0.00001), the time to regular dietary habits (WMD -1.32 days; 95 % CI -2.51, -0.13; P = 0.03), and the time to recover bowel movement (WMD -0.55 days; 95 % CI -0.89, -0.22; P = 0.001). Reoperation rate and mortality were found to be comparable between ELC and EOC. The R0 resection rate and the number of lymph nodes harvested were also comparable between ELC and EOC for malignant diseases. Whether for benign or malignant disease, ELC is a safe and feasible procedure for colonic emergencies compared with EOC, despite being relatively time-consuming.
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Affiliation(s)
- Sun-Bing Xu
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, No. 261, Huansha Road, Hangzhou, 310006 China
| | - Zhong Jia
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, No. 261, Huansha Road, Hangzhou, 310006 China
| | - Yi-Ping Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016 China
| | - Ren-Chao Zhang
- Department of Gastrointestinal Surgery, Zhejiang Provincial People's Hospital, Hangzhou, 310014 China
| | - Ping Wang
- Department of General Surgery, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, No. 261, Huansha Road, Hangzhou, 310006 China
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Daniels M, Merkel S, Agaimy A, Hohenberger W. Treatment of perforated colon carcinomas-outcomes of radical surgery. Int J Colorectal Dis 2015; 30:1505-13. [PMID: 26248792 DOI: 10.1007/s00384-015-2336-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE When patients present with a perforation of a colon cancer (CC), this situation increases the challenge to treat them properly. The question arises how to deal with these patients adequately, more restrictively or the same way as with elective cases. METHODS Between January 1995 and December 2009, 52 patients with perforated CC and 1206 nonperforated CC were documented in the Erlangen Registry of Colorectal Carcinomas (ERCRC). All these patients underwent radical resection of the primary including systematic lymph node dissection with CME. The median follow-up period was 68 months. RESULTS The median age of the patients in the perforated CC group was significantly higher than in the nonperforated CC group (p = 0.010). Significantly, more patients with perforated CC were classified in ASA categories 3 and 4 (p = 0.014). Hartmann procedures were performed significantly more frequently with perforation than with the nonperforated ones (p < 0.001). If an anastomosis was performed, the leakage rate of primary anastomoses did not differ (p = 1.0). Cancer-related survival was significantly lower with perforated cancer (difference 12.8 percentage points) and by 9.6 percentage points for observed survival, if postoperative mortality was excluded. CONCLUSIONS Perforated CC patients should be treated basically following the same oncologic demands, which are CME for colonic cancer including multivisceral resections, if needed. This strategy can only be performed if high-quality surgery is available, permanently.
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Affiliation(s)
- M Daniels
- Universitätsklinikum Erlangen, Chirurgische Klinik, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - S Merkel
- Universitätsklinikum Erlangen, Chirurgische Klinik, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - A Agaimy
- Universitätsklinikum Erlangen, Pathologisches Institut, Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - W Hohenberger
- Universitätsklinikum Erlangen, Chirurgische Klinik, Krankenhausstraße 12, 91054, Erlangen, Germany
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Catastrophic pneumoperitoneum in a patient with perforated colorectal cancer with liver metastasis. Am J Emerg Med 2015; 34:344.e3-5. [PMID: 26242812 DOI: 10.1016/j.ajem.2015.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 11/22/2022] Open
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Teloken PE, Spilsbury K, Levitt M, Makin G, Salama P, Tan P, Penter C, Platell C. Outcomes in patients undergoing urgent colorectal surgery. ANZ J Surg 2014; 84:960-4. [DOI: 10.1111/ans.12580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 12/19/2022]
Affiliation(s)
| | - Katrina Spilsbury
- Centre for Population Health Research; Curtin University; Perth Western Australia Australia
| | - Michael Levitt
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
| | - Gregory Makin
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
| | - Paul Salama
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
- School of Surgery and Pathology; University of Western Australia; Perth Western Australia Australia
| | - Patrick Tan
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
| | - Cheryl Penter
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
- Department of Surgery; University of Western Australia; Perth Western Australia Australia
| | - Cameron Platell
- Colorectal Surgical Unit; St John of God Hospital; Perth Western Australia Australia
- Department of Surgery; University of Western Australia; Perth Western Australia Australia
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Honoré C, Goéré D, Souadka A, Dumont F, Elias D. Definition of Patients Presenting a High Risk of Developing Peritoneal Carcinomatosis After Curative Surgery for Colorectal Cancer: A Systematic Review. Ann Surg Oncol 2012; 20:183-92. [DOI: 10.1245/s10434-012-2473-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 12/17/2022]
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Lampropoulos P, Liarmakopoulos E, Markakis C, Voultsos M, Marinou TR, Marinis A, Hadjimarkou A, Rizos S. Colon cancer perforation presenting as a strangulating ventral hernia. Case Rep Oncol 2012; 5:17-21. [PMID: 22379472 PMCID: PMC3290034 DOI: 10.1159/000335682] [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] [Indexed: 11/19/2022] Open
Abstract
Colorectal cancer remains the second leading cause of death from malignant disease. Despite improvements in the treatment modalities offered to patients, more than half of the operated patients die from the disease. The most common presenting symptoms of colonic carcinoma are changes in bowel habits, bleeding, abdominal pain, abdominal mass, stools mixed with mucus or not, weight loss, anorexia, and other characteristics related to metastasis. Here, the case of a 74-year-old female patient with colon cancer perforation presenting as a strangulating ventral hernia and a mini-review of the current literature are presented.
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