Colonic stent vs surgical resection of the primary tumor. Effect on survival from stage-IV obstructive colorectal cancer

Urgorri, Agustín Seoane; Saperas, Esteban; Castella, Elena O'Callaghan; Román, Miguel Pera; Gil, Agnès Raga; Pons, Fausto Riu; Priego, Luis Barranco; Cuscó, Josep Maria Dedeu; Sánchez, Miguel Pantaleón; Caserras, X. Bessa; Álvarez-González, Marco A.

doi:10.17235/reed.2020.5701/2018

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…In our series, colonic volvulus was the 2nd most common cause of all etiologies (33.4%) and the 1st most common cause of mechanical colonic obstruction (89.4%), and was more frequent in Africa than in the West [6] [8] [13] [23]. In the West, colon occlusions are dominated by tumors in 40% to 70% of cases, and occur preferentially in the left colon [24]. In our series, colonic tumors accounted for only 10.6% of mechanical colon occlusions.…”

Section: Diagnosismentioning

confidence: 98%

Management of Acute Bowel Obstruction in Adults in Ziguinchor Hospital Establishments: About 163 Cases Followed Up

Sow,

Badji,

Dieng

et al. 2024

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Acute intestinal obstruction represents a very frequent admission to surgical emergencies. The aim of our study was to make a descriptive analysis of the management of acute intestinal obstructions at the level of hospital establishments in Ziguinchor. Materials and Methods: This was a retrospective, descriptive, multicenter study from the period of January 1, 2017 to December 31, 2021. Patients over 15 years of age admitted for occlusive syndrome in the two surgical departments of the Ziguinchor regional hospitals were included in the study. Epidemiological, diagnostic, therapeutic and evolutionary data were studied. Results: Acute intestinal occlusions accounted for 8.3% of admissions. A total of 163 patients were enrolled, 61.9% were men, sex ratio of 1.6. The mean age was 48.7 years. The average consultation time was 74.8 hours (3.12 days). The total occlusive syndrome was in 48.5% of the cases. Abdominal pain was present in 87.1%, vomiting in 74.2%, cessation of matter and gas in 60.7% and meteorism in 36.2%. Biological lab tests reported hyperleukocytosis in 28.1% of the cases. Abdominal CT scans were performed in 71.2%, confirming the diagnosis in 90.5% and determining the etiology in 93.1%. The zone of the obstruction in the small bowel was 62.7%, and in the colon in 37.3%. Functional occlusions accounted for 22.7% of cases and mechanical for 77.3%, including 120 cases of strangulation occlusion (95.2%) and 6 cases of obstruction. Etiologies were dominated by adhesions and/or fibrous bands (61.2%). Medical treatment resolved the occlusive syndrome in 9.2% of cases, instrumental treatment in 17.1% and surgical treatment in 77.3%. Adhesiolysis/section of fibrous bands (55.7%), detorsion (14.3%) and resection + anastomosis (11.9%) were the most common surgical procedures.

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Section: Diagnosismentioning

confidence: 98%

Management of Acute Bowel Obstruction in Adults in Ziguinchor Hospital Establishments: About 163 Cases Followed Up

Sow,

Badji,

Dieng

et al. 2024

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“…Another retrospective comparative study conducted in Spain including 95 patients with obstructed inoperable colorectal carcinoma stage IV underwent stenting or emergency surgical resection. They found that both were effective, but surgery did not influence survival; thus, it is not recommended[ 84 ].…”

Section: Managementmentioning

confidence: 99%

Management of obstructed colorectal carcinoma in an emergency setting: An update

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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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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“…Considering the type of sedation to perform and the anesthesiologic support, it is ⃝ Endoscopist position with radiological and endoscopic monitor placed frontally and the endoscopic processor in the right position. 2 ⃝ Nurse position at the end of the radiological bed with an instrument shelf on his side. 3 ⃝ Position of the assistant at the C-arm.…”

Section: Endoscopic Stenting 51 Preparation To Endoscopymentioning

confidence: 99%

“…Colorectal cancer (CRC) is the third most frequently diagnosed malignancy in the world and the second leading cause of cancer-related mortality [1]. About 10-40% of colorectal cancer patients have bowel obstruction at the time of diagnosis, particularly on the left side [2], and large bowel obstruction (LBO) is a common condition that accounts for about 24% of admissions for acute mechanical bowel obstruction [3]. Acute colonic obstruction requires urgent management in order to avoid further complications such as perforation or ischemia.…”

Section: Introductionmentioning

confidence: 99%

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Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management

Mauro,

Scalvini,

Borgetto

et al. 2024

Cancers

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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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Colonic stent vs surgical resection of the primary tumor. Effect on survival from stage-IV obstructive colorectal cancer

Cited by 7 publications

References 37 publications

Management of Acute Bowel Obstruction in Adults in Ziguinchor Hospital Establishments: About 163 Cases Followed Up

Management of Acute Bowel Obstruction in Adults in Ziguinchor Hospital Establishments: About 163 Cases Followed Up

Management of obstructed colorectal carcinoma in an emergency setting: An update

Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management

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