Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon Cancer

Winner, Megan; Mooney, Stephen J.; Hershman, Dawn L.; Feingold, Daniel L.; Allendorf, John D.; Wright, Jason D.; Neugut, Alfred I.

doi:10.1001/jamasurg.2013.1

Cited by 115 publications

(81 citation statements)

References 47 publications

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“…Acute malignant colorectal obstruction occurs in 8-13% of CRC patients (1,2). BTS SEMS placement has been shown to of use in the surgical treatment of patients with OCRC (17).…”

Section: Discussionmentioning

confidence: 99%

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Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

et al. 2017

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Abstract. The placement of a self-expanding metallic stent (SEMS) in obstructive colorectal cancer (OCRC) is acknowledged to be a safe and effective procedure for the relief of obstruction. However, there is concern that shear forces acting on the tumor during stent expansion may release cancer cells into the circulation, resulting in a poor prognosis. The aim of the present study was to determine whether colonic stent insertion increases viable circulating tumor cells (v-CTCs). A telomerase-specific replication-selective adenovirus-expressing GFP (TelomeScanF35) detection system was used to detect v-CTCs in 8 OCRC patients with a SEMS before and after stent insertion and after surgical resection. In 7 patients, a SEMS was inserted as a bridge to surgery (BTS), and in one patient, a SEMS was inserted for palliation. Surgical resection (R0) was performed in 7 patients. Four patients had no v-CTCs before SEMS placement, two of four measurable patients had an increased number of v-CTCs after SEMS placement (1-3 v-CTCs), and one of two patients with increased v-CTCs developed distant lymphatic metastasis despite curative resection. Four patients had v-CTCs (1-19 cells) before SEMS placement, and two of these four patients had an increase in the number of v-CTCs (20-21 cells) after SEMS placement, while one of the four patients died early with distant metastasis. The present study demonstrated that endoscopic stent insertion for OCRC may result in tumor cell dissemination into the peripheral circulation and may induce distant metastases. IntroductionAt the time of the initial diagnosis of colorectal cancer, 8-13% of patients have obstructive symptoms (1,2). The treatment of choice for these patients has traditionally been emergency surgery. However, most studies have found that the morbidity and mortality rates are higher for emergency colorectal surgery than for elective surgery, and a temporary colostomy, which decreases patients' quality of life, is needed in many patients, which, in 10-40% of cases, becomes permanent (3). The purpose of stenting as a bridge to surgery (BTS) is to relieve the acute situation without emergency surgery, allowing elective surgery to be performed and thus improve surgical outcomes, determine the correct tumor stage, detect synchronous lesions, stabilize comorbidities, and carry out laparoscopic surgery. Immediate results in higher surgical risk patients who were stented were better for primary anastomosis, permanent stoma, wound infection, and overall morbidity, resulting in greater benefit. However, stent insertion was recently reported to have a high risk of perforation, re-obstruction, or stent migration (4,5). Moreover, perforations can lead to peritoneal dissemination. Sabbagh et al (6) reported worse overall survival and higher 5-year cancer-specific mortality of left-sided obstructive colorectal cancer (OCRC) patients with self-expanding metallic stent (SEMS) insertion than emergency surgery due to perforation induced by stent insertion. Furthermore, SEMS insertion as a BTS is ...

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“…Acute malignant colorectal obstruction occurs in 8-13% of CRC patients (1,2). BTS SEMS placement has been shown to of use in the surgical treatment of patients with OCRC (17).…”

Section: Discussionmentioning

confidence: 99%

“…At the time of the initial diagnosis of colorectal cancer, 8-13% of patients have obstructive symptoms (1,2). The treatment of choice for these patients has traditionally been emergency surgery.…”

Section: Introductionmentioning

confidence: 99%

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

et al. 2017

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“…AIO develops in around 10% of the patients with CRC [6,7]. It is fact that colorectal operations for an emergency condition have a higher risk of postoperative complication than elective surgeries [8].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Postoperative Morbidity and Mortality in Obstructing Colorectal Cancer

Kılıç¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Amacımız kolorektal kansere bağlı akut barsak tıkanıklığı nedeniyle acil ameliyat edilen hastalarda postoperatif morbidite ve mortaliteye etki eden faktörleri araştırmaktır. Gereç ve Yöntem: Perforasyonsuz tıkayıcı kolorektal kanser nedeniyle ameliyat edilen 43 hasta retrospektif olarak değerlendirildi. Postoperatif morbidite ve mortaliteyi etkileyen ana prognostik faktörleri belirlemek için lojistik regresyon analizi kullanıldı. Bulgular: Postoperatif dönemde 8 (%18.6) hastada mortalite görülür iken, 16 (%37.6) hastada postoperatif morbidite gelişti. Tek değişkenli analizde, 65 üzeri yaşın (p=0.034), eşlik eden sistemik hastalığın (p=0.035), ileri tümör evresinin (p=0.040) ve yüksek ASA skorunun (p=0.000) postoperatif morbidite gelişimi ile ilişkili olduğu bulundu. Öte yandan, 65 üzeri yaş (p=0.023), eşlik eden sistemik hastalık (p=0.014), yüksek ASA skoru (p=0.010) ve uzak metastaz varlığı (p=0.012) postoperatif mortalite ile ilgili risk faktörleri olarak tanımlan-dı. Lojistik regresyon analizi sonrası, yüksek ASA skoru (p=0.005) ve uzak metastaz varlığı (p=0.000), postoperatif mortalitenin bağımsız prognostik faktörleri olarak saptanırken, 65 yaş üzeri yaş (p=0.023) ve yüksek ASA skoru (p=0.000) postoperatif morbiditenin prognostik faktörler olarak belirlendi. Tartışma: İleri yaş ve eşlik eden sistemik hastalık varlığı tıkayıcı kolorektal kanser için acil ameliyat edilen hastalarda postoperatif morbidite ve mortaliteyi artırır. ASA skoru, hem morbidite hem de mortalite için güçlü bir prognostik faktör olarak, preoperatif risk sınıflandırması ve cerrahi planlamada kolaylıkla kullanılabilir. Anahtar KelimelerKolorektal Kanser; Barsak Tıkanıklığı; Morbidite; Mortalite Abstract Aim: Our aim is to investigate the factors affecting on postoperative morbidity and mortality in patients who underwent emergency surgery for acute intestinal obstruction due to colorectal cancer. Material and Method: Fortythree patients who was operated because of acute obstructing colorectal cancer without perforation were retrospectively evaluated. Logistic regression analysis was used to identify the main prognostic factors affecting postoperative morbidity and mortality. Results: Postoperative morbidity was developed in 16 (37.6%) patients while mortality was seen in 8 (18.6%) patients during the postoperative period. In univariate analysis, age above 65 years (p=0.034), accompanying systemic disease (p=0.035), advanced tumor stage (p=0.040), and high ASA score (p=0.000) were found to be associated with the development of postoperative morbidity. On the other hand, age above 65 years (p=0.023), accompanying systemic disease (p=0.014), high ASA score (p=0.010), and presence of distant metastasis (p=0.012) were identified as the risk factors related to postoperative mortality. After logistic regression analysis, age above 65 years (p=0.023) and high ASA score (p=0.000) were determined as the prognostic factors of postoperative morbidity, while high ASA score (p=0.005) and presence of distant metastasis (p=0.000) were found to ...

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“…In a percentage that varies from 7% to 30% of the cases, according to different data, CRC presents as an obstructive form (4)(5)(6), which is often suggestive of an advanced stage and is frequently burdened by a higher surgical complication rate. Furthermore, these patients are generally elderly people with a poor performance status and many comorbidities (7).…”

Section: Introductionmentioning

confidence: 99%

Colonic acute malignant obstructions: effectiveness of self-expanding metallic stent as bridge to surgery

Consolo

Giacobbe²,

Cintolo³

et al. 2017

Turk J Gastroenterol

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Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon Cancer

Cited by 115 publications

References 47 publications

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer

Factors Affecting Postoperative Morbidity and Mortality in Obstructing Colorectal Cancer

Colonic acute malignant obstructions: effectiveness of self-expanding metallic stent as bridge to surgery

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