Results of surgery for colorectal carcinoma with obstruction

Tentes, Antonios-Apostolos K.; Mirelis, Charalambos; Kakoliris, S; Korakianitis, Odisseas; Bougioukas, Ioannis; Tsalkidou, Evanthia; Xanthoulis, Athanasios; Bekiaridou, Konstantina; Dimoulas, A.

doi:10.1007/s00423-008-0307-5

Cited by 18 publications

(23 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mean follow up time was 6.31 months. [33,34] Several studies have found similar disease-specific survival rate for elderly and young colorectal cancer patients, [35,36] but differences in overall survival, indicating that increased mortality in oncogeriatric patients was due to competing cause of death and not to CRC. Therefore, decreased survival in the elderly is mainly due to differences in early mortality.…”

Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05. RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total, 52.63% were female, with sex ratio F:M of 1.11:1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%). There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498). Mean length of hospital stay was 12.78 days (range: 2-31 days; SD 6.31). In-hospital mortality rate was 21.05% (n=4). At follow up, overall survival was 47.36% (n=9). CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected. Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient. One-stage surgery is the best choice, in selected patients. Two-and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

show abstract

Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…ReFeRÊNCIAs O número médio de linfonodos dissecados foi semelhante em ambos os grupos e acima dos 12 linfonodos, padronizados atualmente como mínimo necessário a uma linfadenectomia adequada, demonstrando o critério oncológico adotado nas cirurgias realizadas nos dois grupos, também de acordo com os dados encontrados na literatura 8,9,11,12,15,16,20,21 . A incidência de complicações pós-operatórias foi semelhante nos grupos estudados 7 , sendo maior do que a média relatada na literatura internacional 20 , possivelmente como reflexo de intervenções cirúrgicas em pacientes portadores de lesões avançadas, com menor performance status e pior condição nutricional.…”

Section: Discussionunclassified

“…Em países desenvolvidos, mais de um terço dos pacientes são diagnosticados através de testes de screening populacionais. Nesses países, em séries históri-cas, mesmo após a apresentação de sintomas, cerca de 80% dos casos são operados eletivamente [5][6][7] . Tais dados se contrapõem aos da literatura latino-americana, na qual se apresentam taxas mais altas de pacientes operados em fases avançadas da doença, muitos dos quais em caráter de urgência 8,9 .…”

Section: Introductionunclassified

Ressecções eletiva e de urgência para tratamento de neoplasia maligna do cólon em hospital universitário: estudo de 66 casos

Borba

Brochado

Alcântara

et al. 2011

Rev bras. colo-proctol.

View full text Add to dashboard Cite

120BORBA MR, BROCHADO MCRT, ALCÂNTARA PSM, LIMA TMA, ARANTES TS, OTOCH JP. Ressecções eletiva e de urgência para tratamento de neoplasia maligna do cólon em hospital universitário: estudo de 66 casos. Rev bras Coloproct, 2011;31(2): 120-125.Resumo: o câncer de cólon é uma doença de alta prevalência e mortalidade, cujo tratamento baseia-se na ressecção cirúrgica. A possibilidade de cura aumenta com o diagnóstico precoce, daí a importância dos programas de rastreamento populacional do câncer colorretal. o presente estudo analisou, retrospectivamente, 66 pacientes submetidos a ressecções do cólon por neoplasia em um perío-do de 58 meses no Hospital universitário da universidade de são Paulo. os pacientes foram divididos em dois grupos: grupo 1, submetidos a cirurgia eletiva (28 pacientes), e grupo 2, submetidos a cirurgia de urgência (38 pacientes). os grupos foram comparados com relação às variáveis sexo, idade, apresentação clínica, aspectos da técnica cirúrgica, sítio anatômico da lesão, estádio patológico, taxas de complicações, permanência hospitalar pós-operatória e óbitos na internação. Verificou-se no presente estudo que a idade entre os grupos foi semelhante. Houve uma predominância do sexo masculino entre os pacientes operados de urgência. No grupo de cirurgia eletiva, o principal sintoma foi a hematoquezia, enquanto os operados na urgência, tinham como principal queixa dor abdominal. A grande maioria dos pacientes, no momento da cirurgia, apresentava-se sintomática há meses. os pacientes operados na urgência apresentaram mais tumores pT4 e os operados eletivamente apresentaram mais neoplasias em estádio I. em ambos os grupos, o caráter oncológico dos procedimentos foi preservado, bem como foi alto o índice de anastomoses primárias (81,8%). As taxas de complicações pós-operatórias, o tempo de permanência hospitalar pós-operatório e a mortalidade foram semelhantes. Palavras-chave: câncer de cólon; urgência; complicações; cirurgia.Ressecções eletiva e de urgência para tratamento de neoplasia maligna do cólon em hospital universitário: estudo de 66 casos elective and urgency resections for the treatment of colon neoplasm in university Hospital: study of 66 cases

show abstract

“…While some studies have reported that OCRC has a poorer prognosis than nonobstructing CRC, 4,5 others have found no difference. 6,7 This poses a problem in the surgical management of OCRC.In many institutions, 1-stage primary resection is recommended for OCRC, as this allows colostomy and further nonsurgical drainage for the obstruction to be avoided. [8][9][10] On the other hand, disruption of anastomosis was observed in more than 50% of cases in which resection was performed as initial surgery without surgical or nonsurgical decompression for the obstruction, threatening overall deterioration in the patient's condition.…”

mentioning

confidence: 99%

“…[1][2][3] While some studies have reported that OCRC has a poorer prognosis than nonobstructing CRC, 4,5 others have found no difference. 6,7 This poses a problem in the surgical management of OCRC.…”

mentioning

confidence: 99%

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Kochi

Fujii

Hagiwara

et al. 2015

International Surgery

View full text Add to dashboard Cite

Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and longterm results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P ¼ 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone. While some studies have reported that OCRC has a poorer prognosis than nonobstructing CRC, 4,5 others have found no difference. 6,7 This poses a problem in the surgical management of OCRC.In many institutions, 1-stage primary resection is recommended for OCRC, as this allows colostomy and further nonsurgical drainage for the obstruction to be avoided. [8][9][10] On the other hand, disruption of anastomosis was observed in more than 50% of cases in which resection was performed as initial surgery without surgical or nonsurgical decompression for the obstruction, threatening overall deterioration in the patient's condition.Therefore, some have recommended decompression as a means of avoiding this problem. 11However, the effectiveness of surgical or nonsurgical decompression for OCRC remains controversial.Since January 2001, we have performed preoperative decompression in all OCRC patients to reduce the rate of surgical complications and hospital death.The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing elective surgery for advanced OCRC after preoperative colonic decompression with that in patients undergoing elective surgery alone for advanced nonobstructing CRC. Materials and Methods Patient population and methodsBetween January 2001 and December 2011, a total of 879 consecutive stage I-IV colorectal cancer patients underwent colectomy for primary histologically pr...

show abstract

Results of surgery for colorectal carcinoma with obstruction

Abstract: Obstructing colorectal carcinoma seems to be associated with high mortality rate, but long-term survival seems to be the same with non-obstructing carcinoma.

Cited by 18 publications

References 24 publications

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Ressecções eletiva e de urgência para tratamento de neoplasia maligna do cólon em hospital universitário: estudo de 66 casos

Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Contact Info

Product

Resources

About