ALGORITHM OF SURGICAL CARE IN COMPLICATED COLORECTAL CANCER

AIM: to standardize surgical care for the malignant colonic obstruction. PATIENTS AND METHODS: the retrospective cohort study included 797 patients with complicated colorectal cancer. Malignant colonic obstruction was diagnosed in 572 patients: 247 of them were treated in 2011-2013 (I group); 325 - in 2014-2017 (II). Urgent bowel resection was performed more often in I group (one-stage treatment), fecal diversion or stent- in II (two-stage treatment). Seventy-seven patients with tumor bleeding were included as well: 62 of them were treated conservatively or underwent endoscopic coagulation or arterial embolization (III group); 15 patients - underwent urgent bowel resection (IV). All of 148 patients with bowel perforation were underwent urgent surgery: resection was performed in 115 patients (V), suturing the perforation site-in 15 (VI), extraperitoneal drainage of the abscess - in18 (VII). Elective bowel resection was performed in 241 patients (186 - from I-II group, 40 - from III, 15 - from VI-VII) after 0.1-6 months. The comparative analysis of the early and late results of one- and two-stage treatment was carried out with assessment of the 3-year cumulative survival. RESULTS: postoperative mortality was significantly lower in elective resection groups compared with urgent resection groups: 3.6% vs 29.2% (II vs I); 5.0% vs 20.0% (III vs IV); 0.0% vs 35,7% (VI-VII vs V). The survival rate was higher in elective resection groups than in urgent ones: 0.809 vs 0.680 (II vs I), 0.8882vs 0.3571 (III vs IV), 0.8615 vs 0.4257 (VI-VII vs V). CONCLUSION: multi-stage approach for complicated colorectal cancer is more effective than one-stage.

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Role of endoscopy in diagnosis and treatment of gallstone disease complicated by the pathology of the extrahepatic bilary tract (literature review)

Herald of Pancreatic Club ◽

10.33149/vkp.2020.01.09 ◽

2020 ◽

Vol 46 (1) ◽

pp. 65-71

Author(s):

G. E. Samoilenko ◽

R. P. Klimanskyi ◽

S. O. Zharikov ◽

V. V. Makhnik

Keyword(s):

Biliary Tract ◽

Gallstone Disease ◽

Diagnostic Testing ◽

Intraoperative Ultrasound ◽

Postoperative Mortality ◽

Surgical Care ◽

Percutaneous Transhepatic Cholangiography ◽

Two Stage ◽

One Stage ◽

Complex Approach

The article presents current literature data of domestic and foreign authors on the main problems of endoscopic diagnostics and complex approach to treatment of gallstone disease complicated by pathology of the extrahepatic biliary tract. Efficiency of one-stage and two-stage methods of surgical treatment of cholelithiasis and the possibility of their practical application are considered. Complex approach for minimally invasive bile duct interventions with cholecystoccholedocholitiase, which can be conditionally divided into laparoscopic, mini-access, endoscopic by duodenoscope, cholangioscopy, ultrasound-controlled biliary intervention, is analyzed. Methods of diagnostic testing that can be divided into preoperative and intraoperative, non-invasive and invasive used in patients with cholecystoccholedocholitiase, namely fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, percutaneous-transhepatic cholangiography, diagnostic laparoscopy, intraoperative cholangiography, intraoperative ultrasound, angiography. New concepts of providing surgical care to patients with this pathology are presented, which include one-stage performance of cholecystectomy with priority use of intraoperative antegrade endoscopic papillosphincterotomy, and retrograde litho-extraction under duodenoscope control, in comparison with the two-stage tactics of correction of cholelithiasis with pathology of extrahepatic biliary tract, when the first stage includes its decompression, rehabilitation, and the second — cholecystectomy. Statistical data of complications arising during diagnostic and therapeutic manipulations in patients with cholelithiasis complicated by pathology of the extrahepatic biliary tract are presented. Number of cases of postoperative mortality depending on the severity of complications of cholelithiasis is also considered.

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Treatment strategy for obstructive colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.741 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 741-741

Author(s):

Shiro Iwagami ◽

Nobutomo Miyanari ◽

Tatsuo Kubota ◽

Yousuke Nakao ◽

Takanobu Yamao ◽

...

Keyword(s):

Colorectal Cancer ◽

Perioperative Complications ◽

Tumor Resection ◽

Treatment Strategies ◽

Stage Iv ◽

Two Stage ◽

Obstructive Colorectal Cancer ◽

One Stage ◽

Number Of Patients ◽

Resection And Anastomosis

741 Background: The number of patients with colorectal cancer has been increasing in all over the world. Approximately 10 percent of CRC is complicated by obstructive symptoms at the time of their diagnosis. Obstructive colorectal cancer (OCRC) could be a fatal because of perforation peritonitis or sepsis, and it is necessary to immediate treatment. The aim of this study was to explore the treatment strategies for patients with OCRC. Methods: Between April 2008 and December 2014, six hundred seventy two patients underwent surgery in out institute. The numbers of OCRC were 82 cases (12.2%). We evaluated the feasibility and effectiveness of our treatments for OCRC. Results: Treatment strategies were adopted according to the location of CRC. For patients with right-sided OCRC, we performed one-stage surgery. They underwent primary tumor resection and anastomosis at the same time. For left-sided OCRC, patients were treated by two-stage surgery. At first, they were managed by decompression of their colon with colostomy or transanal ileus tube, and then, underwent colectomy. The cases of right-side OCRC were 23 cases, and all of them underwent one-stage surgery. We could find no cases of anastomotic leakage in these cases. The cases of left-side OCRC were 59 cases, and 50 patients (86%) of them were treated two-stage surgery. Stage IV OCRC patients tended to undergo colostomy only. Conclusions: One-stage surgery was feasible for patients with right-sided OCRC. For left-sided OCRC cases, two-stage surgery was effective to prevent perioperative complications.

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Mo1628 One-Stage Colectomy With Intraoperative Colonic Irrigation for Acute Left-Sided Malignant Colonic Obstruction

Gastroenterology ◽

10.1016/s0016-5085(15)33941-x ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1155

Author(s):

Shimpei Otsuka ◽

Yuji Kaneoka ◽

Atsuyuki Maeda ◽

Yuichi Takayama

Keyword(s):

Colonic Obstruction ◽

Colonic Irrigation ◽

One Stage ◽

Malignant Colonic Obstruction

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One-Stage Colectomy with Intraoperative Colonic Irrigation for Acute Left-Sided Malignant Colonic Obstruction

World Journal of Surgery ◽

10.1007/s00268-015-3078-5 ◽

2015 ◽

Vol 39 (9) ◽

pp. 2336-2342 ◽

Cited By ~ 6

Author(s):

Shimpei Otsuka ◽

Yuji Kaneoka ◽

Atsuyuki Maeda ◽

Yuichi Takayama ◽

Yasuyuki Fukami ◽

...

Keyword(s):

Colonic Obstruction ◽

Colonic Irrigation ◽

One Stage ◽

Malignant Colonic Obstruction

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COMPARATIVE RESULTS OF RECOVERY STAGE IN TWO-STEP TREATMENT OF MALIGNANT COLONIC OBSTRUCTION

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-1-70-75 ◽

2017 ◽

Vol 176 (1) ◽

pp. 70-75

Author(s):

V. I. Pomazkin

Keyword(s):

Colonic Obstruction ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Main Group ◽

Control Group ◽

Recovery Stage ◽

Malignant Colonic Obstruction ◽

Analysis Of Results ◽

Comparative Results ◽

Adhesion Process

The aim of the study was a comparative analysis of results of different approaches to two-stage treatment of malignant colonic obstruction on the stage of recovery of the integrity of intestinal tract. The main group included 260 patients. A double-barreled colostomy was formed at the first stage, than resection of the colon with tumor removing and stoma excision were performed. The control group consisted of 192 patients. An obstructive resection of the colon was made at the first stage with following reconstructive operation. Intraoperative damage of the small intestine was observed in 6,9% patients of the main group and 18,2% patients of the control group. Postoperative mortality consisted of 1,2% in the main group and it was 1,5% in the control group. The early postoperative complications numbered 9,2% and 17,7%, respectively. The main risk factor of complication development was an expressed adhesion process of the abdominal cavity in the control group of patients. CONCLUSIONS. The method, which included the colostomy formation at the first stage with following radical surgery at the second stage, had advantages in case of elimination of malignant colonic obstruction.

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A systematic review and meta-analysis on the management of concomitant abdominal aortic aneurysms and renal tumours

Vascular ◽

10.1177/17085381211026827 ◽

2021 ◽

pp. 170853812110268

Author(s):

Katerina Lawrie ◽

Adam Whitley ◽

Peter Balaz

Keyword(s):

Endovascular Procedures ◽

Meta Analysis ◽

Postoperative Mortality ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Two Stage ◽

One Stage ◽

Abdominal Aortic ◽

Renal Tumours ◽

Aneurysm Repair

Objectives The treatment of concomitant abdominal aortic aneurysms and renal tumours is controversial. The aim of this study was to ascertain which of the following three strategies, one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy or two-stage endovascular aneurysm repair and nephrectomy, is the best approach. Methods systematic review and meta-analysis of articles published between January 1992 and April 2021 describing the treatment of concomitant abdominal aortic aneurysms and renal tumours. Results A total of 1168 records were identified. After the selection process, 12 studies with data on 89 patients were included. Sixty-two patients underwent one-stage open procedures, 18 patients underwent two-stage open procedures and nine underwent two-stage endovascular procedures. The overall postoperative mortality was 0.82% (95% CI, 0.00–4.61). The postoperative mortality for one-stage open procedures was 3.09% (95% CI, 0.00–10.11). No deaths occurred in the postoperative period open two-stage procedures or two-stage endovascular procedures. The weighted postoperative morbidity for all procedures was 23.86% (95% CI, 12.64–35.08) and for open one-stage procedures was 37.40% (95% CI, 14.33–60.47). Data concerning postoperative complications of two-stage open procedures were extractable from only one patient in whom no complications were reported. Two postoperative complications were reported after two-stage endovascular procedures from a total of six patients with extractable postoperative data. We were unable to perform meta-analysis on long-term outcomes as the data were reported non-uniformly. Conclusion There is currently no evidence to suggest that any procedure is associated with better outcomes. However, a one-stage open approach was the most commonly used option, favoured as it avoids delaying treatment of either of the conditions. Two-stage open procedures were preferred in cases where the surgical risk of a one-stage procedure was higher than the potential benefit. For such cases, two-stage endovascular repair is becoming more popular as a less invasive approach.

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Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

Pelvic Surgery and Oncology ◽

10.17650/2686-9594-2021-11-1-21-27 ◽

2021 ◽

Vol 11 (1) ◽

pp. 21-27

Author(s):

S. N. Shchaeva ◽

L. A. Magidov

Keyword(s):

Colorectal Cancer ◽

Primary Anastomosis ◽

Severe Disease ◽

Postoperative Mortality ◽

Tumor Removal ◽

Two Stage ◽

Factors Affecting ◽

Tumor Perforation ◽

Type Of Surgery ◽

D Dimer

Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

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