Background: Malignant bowel obstruction (MBO) is defined as the evidence of obstruction distally to the Treitz ligament in the presence of a malignant peritoneally disseminated neoplasm. Patients with this condition suffer from decreased quality of life due to impaired food intake, recurrent nausea, and abdominal pain. The objective was to investigate the outcome of patients with MBO surgically treated, considering post-treatment survival, surgical morbidity, and length of hospital stay, in order to assess the efficiency and impact of surgery at this advanced stage of disease. Methods: We reviewed retrospectively data collected from 198 patients diagnosed with MBO at Instituto do Câncer do Estado de São Paulo (ICESP), operated between 2018 and 2021. Results: Among preoperative factors, advanced stages and poor clinical status were associated with earlier death (stage IV had 4.53 higher chance of death). On the other hand, patients considered candidates for invasive life support measures had longer postoperative survival (non-candidates had a chance 1,000,000 times higher of death). Primary diagnosis also showed to be an important risk factor: ovary malignancies had higher risk of surgical complications (OR of 14.28), when compared to gastric and colon cancers. Considering intraoperative factors, patients who underwent resections had better long-term survival (9.9 months) than those who underwent bypass (1.3 months) or stomas (2 months); p=0.017. Finally, considering post-operative factors, long-term survival was associated with shorter hospital stay (p=0.001). Conclusions: Medical and surgical treatment should be employed on a case-by-case basis, after taking into consideration multiple pre-operative factors, such as KPS and primary tumor stage.
Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy. Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment. Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed. Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period. Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease.
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