Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice

Detalhes bibliográficos
Autor(a) principal: Fernandes, D
Data de Publicação: 2016
Outros Autores: Domingues, S, Gonçalves, BM, Bastos, P, Ferreira, A, Rodrigues, A, Gonçalves, R, Lopes, L, Rolanda, C
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.23/1203
Resumo: INTRODUCTION: Colorectal cancer presents itself as acute bowel occlusion in 10-40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS). AIMS AND METHODS: This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013. RESULTS: Globally (85 patients - 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004). CONCLUSION: SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.
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spelling Acute Treatment of Malignant Colorectal Occlusion: Real Life PracticeNeoplasias ColorrectaisObstrução IntestinalStentsINTRODUCTION: Colorectal cancer presents itself as acute bowel occlusion in 10-40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS). AIMS AND METHODS: This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013. RESULTS: Globally (85 patients - 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004). CONCLUSION: SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.Repositório Científico do Hospital de BragaFernandes, DDomingues, SGonçalves, BMBastos, PFerreira, ARodrigues, AGonçalves, RLopes, LRolanda, C2017-09-08T11:47:15Z2016-01-01T00:00:00Z2016-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.23/1203engGE Port J Gastroenterol. 2016 Jan 29;23(2):66-75.10.1016/j.jpge.2015.10.005info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2022-09-21T09:03:05Zoai:repositorio.hospitaldebraga.pt:10400.23/1203Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T15:55:45.090803Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
title Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
spellingShingle Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
Fernandes, D
Neoplasias Colorrectais
Obstrução Intestinal
Stents
title_short Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
title_full Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
title_fullStr Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
title_full_unstemmed Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
title_sort Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice
author Fernandes, D
author_facet Fernandes, D
Domingues, S
Gonçalves, BM
Bastos, P
Ferreira, A
Rodrigues, A
Gonçalves, R
Lopes, L
Rolanda, C
author_role author
author2 Domingues, S
Gonçalves, BM
Bastos, P
Ferreira, A
Rodrigues, A
Gonçalves, R
Lopes, L
Rolanda, C
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório Científico do Hospital de Braga
dc.contributor.author.fl_str_mv Fernandes, D
Domingues, S
Gonçalves, BM
Bastos, P
Ferreira, A
Rodrigues, A
Gonçalves, R
Lopes, L
Rolanda, C
dc.subject.por.fl_str_mv Neoplasias Colorrectais
Obstrução Intestinal
Stents
topic Neoplasias Colorrectais
Obstrução Intestinal
Stents
description INTRODUCTION: Colorectal cancer presents itself as acute bowel occlusion in 10-40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS). AIMS AND METHODS: This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013. RESULTS: Globally (85 patients - 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004). CONCLUSION: SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.
publishDate 2016
dc.date.none.fl_str_mv 2016-01-01T00:00:00Z
2016-01-01T00:00:00Z
2017-09-08T11:47:15Z
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.23/1203
url http://hdl.handle.net/10400.23/1203
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv GE Port J Gastroenterol. 2016 Jan 29;23(2):66-75.
10.1016/j.jpge.2015.10.005
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