EP.TU.70The Conservative Management of Perforated Diverticulitis Based on Abscess Size and Presence of Distant Air

Abstract Aims To determine the effectiveness of conservative management in perforated diverticulitis (PD) in a single District Hospital based on the size of the abscess and the presence of distant air (DA). Methods Data on 112 Patients who were admitted between 2013-2018 with PD was collected retrospectively. CT scan reports were used to document the size of abscess and presence of DA. Failed conservative management with antibiotics (ABx) was defined as the need for another therapeutic option after 48 hours of admission or readmission within 90 days. Results Overall, 40 patients (36%) needed operative management, 12 patients (11%) required washout, 6 patients (5%) underwent radiological drainage and 8 patients (7%) were offered best supportive care. In total, 46 patients (41%) were successfully managed with ABx only. ABx were tried on 45 patients who had <4cm abscess and no DA. This was successful in 30 of them (66%). However, 6 out of 17 patients (35%) with >4cm abscess and no DA were treated with ABx only. Despite presence of DA, 8 out of 17 (47%) cases with <4cm abscess were successfully treated with Abx only. Only 2 patients out of 19 (10%) with >4cm and DA were successfully treated with ABx only. Conclusion Abscess size and presence of DA in PD should be considered in predicting the outcome of the management. Even in presence of DA, nearly half of patients with small abscesses (<4cm) diverticular abscesses were successfully managed conservatively. The majority of patients with larger abscesses with DA failed ABx treatment.

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Impact of a geriatric oncology (GO) clinic on cancer treatment plans and supportive care for older adults with genitourinary (GU) cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.238 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 238-238

Author(s):

Shabbir M.H. Alibhai ◽

Allison Loucks ◽

Rana Jin ◽

Martine Puts ◽

Sarah Watt ◽

...

Keyword(s):

Older Adults ◽

Supportive Care ◽

Treatment Plan ◽

Tertiary Care ◽

Geriatric Oncology ◽

Operative Management ◽

Best Supportive Care ◽

Care Hospital ◽

Treatment Plans ◽

The Impact

238 Background: Older adults with cancer are complex due to multiple comorbidities, polypharmacy, and functional/cognitive impairments, leading to over-treatment and undertreatment. Studies examining the impact of geriatric assessment (GA) in older adults with various cancers found a median of 39% of treatment plans were revised after the GA ( Ann Oncol 2014; 25:307). Although these findings support the need for a GO clinic, whether such a clinic leads to changes in treatment in patients with GU malignancies is not clear. We examined the impact on the treatment plan of a GO assessment in GU patients, along with other enhancements to patient care for consecutive patients referred to the GO clinic in a tertiary care hospital. Methods: All referred older adults (age 65+) with a GU malignancy seen in the GO clinic at the Princess Margaret Cancer Centre, Toronto, Canada between July 2015 and June 2017 were included. Patients were seen by a geriatric oncologist and GO nurse and treatment recommendations were provided to the referring oncologist. Pre- and post-GO clinic treatment plans and enhancements to supportive care were recorded prospectively. Analyses were descriptive. Results: 98 patients (mean age 80) were seen in the GO clinic, of whom 35 were seen pre-treatment (25 prostate, 5 kidney, 5 bladder). 31 of 35 were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients. Overall, GO resulted in a treatment modification in 52% of patients. Enhancements to care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%). Conclusions: The GO clinic results in modifications to the proposed treatment plan in over half of referred patients (predominantly a reduction in treatment intensity), and enhancements to care in the vast majority of patients. GO clinics have the potential to avoid overtreatment and improve care for older adults with GU malignancies.

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1565 In Covid-19 Pandemic, Following the Updated Royal College of Surgeons of England Guidelines in Management of Acute Appendicitis; A General District Hospital Audit

British Journal of Surgery ◽

10.1093/bjs/znab259.176 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Dorra ◽

M Abdellatif ◽

W Fahmy ◽

Y Salama

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Royal College ◽

Conservative Management ◽

District Hospital ◽

Admission Rate ◽

Operative Management ◽

Operative Intervention ◽

Coding System ◽

Conservative Group

Abstract Aim The Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues. Method Collection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020. Results The collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group. Conclusions The work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

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1475 Management of Appendicitis During COVID19 - A Shift to Conservative Management

British Journal of Surgery ◽

10.1093/bjs/znab259.507 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Bhattacharya ◽

S Stonelake ◽

E Peterknecht ◽

S Zaman ◽

M Budhoo

Keyword(s):

Ct Scan ◽

Conservative Management ◽

Operative Management ◽

Median Length ◽

Conservative Group ◽

Uncomplicated Appendicitis ◽

Retrospective Data Collection ◽

Surgical Conditions ◽

Versus Risk

Abstract Introduction The COVID19 pandemic posed challenges in dealing with common surgical conditions, by causing a redirect of manpower and resources as well as having correlation of added morbidity if present in patients undergoing surgery Aim To find out the proportion of patients undergoing conservative management and their outcomes compared to operative management Method Retrospective data collection of patients admitted with appendicitis from 25/03/2020 to 15/07/2020. Results A total of 72 encounters had a discharge diagnosis of appendicitis.35 (48.6%) patients were treated with conservative management. while 37 (51.4%) patients had operative management. In the conservative group CT scan was done in 64%, which showed simple appendicitis in 78% and complicated in 17 %, whereas in the operative group CT scan was done in 59.4% , 86 % had simple appendicitis and 9% and complicated appendicitis. Median length of stay in both groups were 2 days. There were no readmissions in the operative group and 84.3% patients had no readmissions in the conservative group in the study in a follow up period up to 6 months. 2 patients initially treated conservative were eventually offered surgery on readmission. Conclusions 1. Conservative management of appendicitis has proved to be a valuable alternative to surgical management during this pandemic 2. Patients should be offered a choice of conservative management for simple appendicitis with prior discussion of benefits of avoiding surgery versus risk to recurrence (up to 39% reported in literature for uncomplicated appendicitis)

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O23 Outcomes after non-operative management of perforated diverticular disease: a population based cohort study

British Journal of Surgery ◽

10.1093/bjs/znab282.028 ◽

2021 ◽

Vol 108 (Supplement_5) ◽

Author(s):

A Adiamah ◽

L Ban ◽

H Otete ◽

C J Crooks ◽

J West ◽

...

Keyword(s):

Cohort Study ◽

Diverticular Disease ◽

Conservative Management ◽

Case Fatality ◽

Operative Management ◽

Population Based ◽

Perforated Diverticulitis ◽

Clinical Practice Research Datalink ◽

Non Operative Management

Abstract Introduction The management of perforated diverticular disease has changed in the last 10 years with a move towards less surgical intervention. This population based cohort study aimed to define the risk of mortality and readmission following non-operative management of perforated diverticular disease (DD). Method Patients diagnosed with perforated DD and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case-fatality, re-admissions and surgery at re-admission. Result In total, 880 patients with perforated DD were managed without surgery, comprising of 523 females (59.4%). One year case-fatality was 33.2% (293/880). The majority of deaths occurred in the first 90 days following the index admission with a 90 day case-fatality of 28.8%. 90 day survival varied by age with 97.2% survival at 90 days in those under 65 years compared to 85.0% in those between 65–74 years and 51.5% in those over 75 years. Of 767 patients discharged from hospital, 250 (32.6%, 250/767) were re-admitted (47 elective(6.1%) and 203 emergency(26.5%)) during a median of 1.6 years of follow-up (iqr 0.1–3.9 years) with similar proportions in each age category. In the first year of follow-up only 5.1% of patients required surgery of whom 16/767 (2.1%) required elective and 23/767 (3.0%) emergency surgery. Conclusion Conservative management of perforated diverticulitis in those under 65 years is feasible and safe. A third of patients are readmitted during follow-up, however, re-intervention rates following conservative management were low across all age categories. Take-home Message In younger patients (<65yrs) conservative management of perforated diverticulitis is feasible and safe. A third of conservatively managed patients are readmitted during follow-up, however, need for surgery on readmission is rare.

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Cholangiokarzinome

Praxis ◽

10.1024/0369-8394.91.34.1352 ◽

2002 ◽

Vol 91 (34) ◽

pp. 1352-1356

Author(s):

Harder ◽

Blum

Keyword(s):

Supportive Care ◽

Evidence Based Medicine ◽

Best Supportive Care ◽

Evidence Based ◽

Systemische Chemotherapie ◽

Chirurgische Resektion ◽

Multimodale Therapiekonzepte ◽

Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

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Randomisierte Phase-IIb-Studie mit Pexa-Vec (pexastimogene devacirepvec; JX-594), eine onkolytische Immuntherapie mit Best Supportive Care (BSC) gegen BSC allein bei Patienten mit Leberzellkarzinom (HCC) und fehlgeschlagener Sorafenib-Behandlung (TRAVERSE)

Zeitschrift für Gastroenterologie ◽

10.1055/s-0035-1559145 ◽

2015 ◽

Vol 53 (08) ◽

Cited By ~ 1

Author(s):

M Moehler ◽

G Ungerechts ◽

C Springfeld ◽

H Wege ◽

T Werner ◽

...

Keyword(s):

Supportive Care ◽

Best Supportive Care

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A randomized phase III trial comparing trabectedin to best supportive care in patients with pre-treated soft tissue sarcoma: T-SAR, a French Sarcoma Group trial

Annals of Oncology ◽

10.1016/j.annonc.2021.04.014 ◽

2021 ◽

Author(s):

A. Le Cesne ◽

J.-Y. Blay ◽

D. Cupissol ◽

A. Italiano ◽

C. Delcambre ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Supportive Care ◽

Best Supportive Care ◽

Phase Iii ◽

Phase Iii Trial ◽

Group Trial

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Fallbericht: Best Supportive Care (BSC) in der Palliativmedizin – was bedeutet BSC eigentlich?

TumorDiagnostik & Therapie ◽

10.1055/a-1351-8724 ◽

2021 ◽

Vol 42 (02) ◽

pp. 125-129

Author(s):

Eva-Maria Kretschmer ◽

Tanja Krones ◽

David Blum

Keyword(s):

Supportive Care ◽

Best Supportive Care ◽

Onkologische Therapie ◽

Patient Hatte

ZusammenfassungWir berichten über einen multimorbiden 56-jährigen Patienten, welcher mit unbehandelter Tumorerkrankung nach Multiorganversagen auf die Palliativstation verlegt wurde. Aufgrund einer Eisenmangelanämie wurde eine Magen-Darm-Diagnostik zum Ausschluss einer gastrointestinalen Blutung durchgeführt. Diese Untersuchung zeigte ein Adenokarzinom des proximalen Kolons. Im Rahmen der Narkoseeinleitung zur Resektion des Tumors aspirierte der Patient und entwickelte einen schweren septischen Schock mit Multiorganversagen.Entsprechend der interdisziplinären Tumorboardempfehlung für Best Supportive Care (BSC) sowie dem vom Patienten gewünschten Abbruch der Therapie, erfolgte die Zuweisung auf die Palliativstation. Der voll urteilsfähige Patient hatte im Zuge der aus seiner Sicht dramatischen Ereignisse keine weiteren intensivmedizinischen Maßnahmen gewünscht.Im weiteren Verlauf der insgesamt fünfwöchigen Behandlung auf der Palliativstation stabilisierte sich der Patient. Dank intensiver Gespräche mit unterschiedlichen Professionen der Palliativmedizin über Therapieziele und die eigenen Präferenzen beschäftigte sich der Patient mit dem Lebensende und bereitete sich auf den Tod vor. Es zeigte sich, dass die Ablehnung weiterer intensivmedizinischer Maßnahmen aus Patientensicht keinen generellen Verzicht auf die Behandlung der Tumorerkrankung beinhaltete.Schließlich konnte bei vollständiger Rekonvaleszenz die geplante onkologische Therapie mit neoadjuvanter Chemotherapie und Tumorresektion erfolgreich durchgeführt werden.

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