Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery

Boer, Nadine L. de; Hagemans, J.A.W.; Schultze, Bob T.A.; Brandt-Kerkhof, Alexandra R M; Madsen, Eva; Verhoef, Cornelis; Burger, Jacobus W. A.

doi:10.1016/j.ejso.2018.12.015

Cited by 32 publications

(22 citation statements)

References 17 publications

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“…This series reports the longest follow-up for GEP-NEN patients after the diagnosis of PC (median 53.5 months). Its rationale was led by clinical practice, as in a significant proportion of patients PC is not an accidental finding but can seriously affect the clinical course, causing a broad spectrum of symptoms [3]. Our data show size of peritoneal implants as the main risk factor for bowel obstruction (HR: 1.10, 95% CI: 1.02-1.20; p = 0.01).…”

Section: Peritoneal Disease Controlmentioning

confidence: 65%

“…Although it frequently represents an occasional finding during disease staging or follow-up, in some patients it can instead negatively influence quality of life, with deterioration of clinical status. PC can indeed cause recurrent abdominal pain or even bowel obstruction, with bloating, nausea, and vomiting as additional clinical presentation and need of surgery in a subgroup of patients [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Peritoneal Carcinomatosis in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: Clinical Impact and Effectiveness of the Available Therapeutic Options

et al. 2019

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Background: Peritoneal carcinomatosis (PC) can affect the quality of life of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Peritoneal disease control by medical therapies in these patients has been poorly investigated Objectives: To describe, in a consecutive series of GEP-NENs, the clinical impact of PC and to report the effectiveness of available treatments in PC control. Methods: A retrospective, monocenter analysis was performed of 135 GEP-NENs (1993-2016 with at least a 12-month follow-up. Peritoneal disease progression was defined as detection of a significant increase in size or appearance of new implants by imaging. Results: A total of 62.9% of cases had diffuse PC (involving at least 2 abdominal quadrants). According to WHO 2017 classification, cases were 42.3% neuroendocrine tumors NET-G1, 45.5% NET-G2, 6.5% NET-G3, 4.9% neuroendocrine carcinomas NEC-G3, and 0.8% mixed neuroendocrine-nonneuroendocrine neoplasms. Bowel obstruction occurred in 30 (22.2%) patients mainly depending on size of peritoneal implants (HR: 1.10; 95% CI: 1.02-1.20; p = 0.01). Patients with diffuse PC treated with peptide receptor radionuclide therapy (PRRT) showed peritoneal progression in 37.5% of cases, and bowel obstruction or ascites in 28.1%. Better peritoneal disease control was observed in cases receiving somatostatin analogs at first-line therapy, probably due to a less aggressive disease behavior for these patients. Conclusions: Bowel obstruction is not uncommon in GEP-NENs with PC. PRRT should be adopted with caution in GEP-NENs with diffuse PC, but larger series are needed to confirm these data.

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Section: Peritoneal Disease Controlmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Peritoneal Carcinomatosis in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: Clinical Impact and Effectiveness of the Available Therapeutic Options

et al. 2019

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“…Malignant bowel obstructions are one of the paradigm conditions that exemplify the existence of a variety of potential treatment pathways such as conservative management, minimally invasive interventions such as decompressive gastric tubes versus full surgical intervention. 38 , 39 , 40 The existence of these treatment options that can be chosen based on patient preferences, values and goals lends itself to communication frameworks such as “Best Case/Worst Case”. 20 It is also important to keep in mind that the population of patients with advanced malignancies of the lower gastrointestinal tract is very heterogeneous.…”

Section: Specific To Colon and Rectal Surgerymentioning

confidence: 99%

Improving quality in colon and rectal surgery through palliative care

Rivet

Sullivan

Noreika

2020

Seminars in Colon and Rectal Surgery

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Palliative care is a medical discipline that emphasizes quality of life and can be provided in parallel with recovery-directed treatments in colon and rectal surgery. Palliative care is receiving increasing attention and investigation for its potential to improve quality and outcomes for a wide spectrum of patients by benefiting symptom management, supporting complex health care decision making and facilitating care transitions. Primary palliative care refers to the application of palliative care principles by clinicians of all disciplines whereas specialty palliative care is a multidisciplinary approach and includes a clinician with advanced training and experience.

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“…On the other hand, performing palliative surgery on poor surgical candidates like those with MBO is challenging because of the reduced life expectancy and the poor general conditions (6). This implies that even a standard surgical procedure can be associated with high postoperative morbidity and mortality (3,7).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

et al. 2021

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Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.

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Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery

Cited by 32 publications

References 17 publications

Peritoneal Carcinomatosis in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: Clinical Impact and Effectiveness of the Available Therapeutic Options

Peritoneal Carcinomatosis in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: Clinical Impact and Effectiveness of the Available Therapeutic Options

Improving quality in colon and rectal surgery through palliative care

Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

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