COLODUODENAL FISTULA IN RIGHT COLORECTAL CANCER: CASE REPORT AND REVIEW OF THE LITERATURE

In spite of the high incidence of colorectal cancer, cases of right colon cancer presenting with local invasion are not common. This is even more infrequent if we focus on duodenal invasion and presence of duodenal fistula. We present the case of a patient admitted to our hospital due to severe weight loss, malnutrition and bowel obstruction. The patient was diagnosed of advanced right colon cancer with coloduodenal fistula and concomitant liver metastasis. According to diagnosis, palliative surgery was performed

Prediction of the biological behavior of tumors: colorectal cancer case study. Retrospective and future outlook

Attempts to determine the biological behavior of tumors have been an integral part of research in oncology for nearly 100 years. During this period, many works have been carried out to assess the value of individual factors, including both clinical information about the patient and the pathomorphological features of the tumor. Various systems have been proposed and modified, combining all possible combinations of neoplasm characteristics and epidemiological parameters. Thus, approaches to predicting the biological behavior of tumors can be conditionally divided into two types: the first, an analytical approach, is based on revealing individual morphological or clinical factors that affect the course of the tumor process, and the second, a systemic approach, which consists in combining several related and interacting constitute signs into a unified predictive model. Existing tumor classification systems are far from perfect. Nevertheless, the general consensus among pathologists, surgeons, and clinical oncologists is that prognosis parameters deserve to be a part of the standard pathology report for most tumors.

“Stent in Stent” Procedure for Treatment of Extreme Strictures of Colorectal Cancer – Case Series in a Single Center: How to Do it

Background: Since 1990’s the use of self-expanding metal stent has been known. Initially, this kind of technique has been debated in literature. Actually, is a widely used technique for treatment of bowel neoplastic obstruction. This procedure is important to restore bowel canalization but is feasible performed by expert endoscopists and a dedicated anesthesiologist team. More difficult seems to be the treatment of strictures longer than 9 cm of large bowel or synchronous very close stenosis of rectal-sigmoid junction and rectum. This technical note demonstrated how SEMS positioning can be performed for treatment of long and extreme large bowel obstruction. Methods: In this case series we have treated all patients admitted in our department with diagnosis of extreme bowel neoplastic obstruction, with “stent in stent” technique, in deep sedation. Results: From January to August 2019 we admitted in our Surgical and Endoscopic Unit two patients, a 90- year-old for bowel obstruction by synchronous colorectal cancer and a 80-year-old female for 15 cm large bowel neoplastic obstruction. Patients were submitted to “Stent-in-Stent” technique. No complications and perforation were observed with restore of bowel canalization after few hours from SEMS positioning. Both patients had no signs of bowel obstruction at abdomen X-Ray control, after 48 hours. 80-year-old female patient was submitted to left colectomy after 6 days without complications, while 90-year-old was discharge after 3 days. Conclusion: This study demonstrated how is possible to perform endoscopic SEMS positioning to treat longer than 15 cm neoplastic large bowel obstruction and synchronous colorectal cancer with “Stent-inStent” technique. Our technical note describes, point by point, all passages of this procedure and suggests as is possible to treat synchronous sigmoid-rectal neoplastic obstruction using two different kind of metal stent.