Current management of acute malignant large bowel obstruction: a systematic review

Frago, Ricardo; Ramı́rez, Elena; Millán, Mónica; Kreisler, Esther; Valle, Emilio del; Biondo, Sebastiano

doi:10.1016/j.amjsurg.2013.07.027

Cited by 185 publications

(106 citation statements)

References 70 publications

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“…15 CT is also useful for accurately defining the level (94%) and aetiology (81%) of the obstruction, as well as local and distant disease staging in the majority of patients. [15][16][17] CT scanning will also reliably demonstrate if there is perforation at the site of tumour or caecum when stenting would be inappropriate. The diameter of the caecum also provides an indication of the urgency of decompression; caecal perforation is much more likely if there is a closed loop obstruction and when the diameter of the caecum is 14 cm or greater.…”

Section: General Considerations and Techniquementioning

confidence: 99%

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Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Section: General Considerations and Techniquementioning

confidence: 99%

“…4,16 Although there are no RCTs to support this practice, surgery for right-sided colonic obstruction has lower morbidity and mortality than that for left sided obstruction, and SEMS placement is more challenging. 15 Rectal cancers have been excluded from all but one of the published RCTs on stenting.…”

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confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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“…Malignant colorectal obstruction (MCRO) caused by advanced colonic cancer occurs in 8%-13% of colonic cancer patients (2,3), however, the management of this clinical condition remains controversial (4). Patients with malignant MCRO tend to have advanced disease and be poor surgical candidates.…”

Section: Introductionmentioning

confidence: 99%

Outcome of endoscopic self-expandable metal stents in acute malignant colorectal obstruction at a tertiary center

Rodrigues‐Pinto¹,

Pereira²,

Lopes³

et al. 2015

Rev Esp Enferm Dig

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Background: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS) may be used in acute MCRO.Aim: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance.Methods: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period.Results: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19) and palliation in the remaining 60% (n = 28). The location of the tumor did not influence the presence of lymph node involvement (p = 0.764) nor metastasis (p = 0.885). Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001). Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385), early (p = 0.950) or late complications (p = 0.057). Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%.Conclusions: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance.

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“…Она позволяет определить причину кишечной непроходимости, выполнить био-псию, дает возможность провести лечебные меропри-ятия, направленные на разрешение острой кишечной непроходимости [2,3,[6][7][8]. Противопоказанием к проведению колоноскопии является декомпенсиро-ванная кишечная непроходимость, сопровождающа-яся диастатическими разрывами стенки кишки или высоким риском их развития, перитонитом, край-не тяжелым общим состоянием больного [4,5,8,9].…”

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“…Колоноскопия может быть использована для вы-явления уровня обструкции и верификации диагноза путем выполнения биопсии опухоли, также с лечебной целью -для применения эндохирургических методик восстановления пассажа кишечного содержимого, которые могут быть как дополнением, так и альтерна-тивой хирургическому лечению опухолевой кишечной непроходимости [8,9]. Согласно обзору последних рекомендаций разрешения острой обтурационной толстокишечной непроходимости (ООТКН), сущест-вует 2 показания к эндопротезированию ТК [2,3,5]:…”

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Colorectal stenting in cancer patients

Юричев¹,

Карасев²,

Vereshchak³

et al. 2018

Onkol. koloproktol.

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Background. Malignant colonic obstruction (MCO) it is one of the most common and severe complications of colon and rectal cancer. The mechanisms underlying MCO development include impairments in motor, secretory and resorptive functions of the intestine, disorders of water-electrolyte metabolism, endotoxicosis, and compartment syndrome. All of these conditions significantly reduce patient survival.Objective: to compare the outcomes of colonic stenting in patients with primary and secondary tumors and to assess the efficacy of surgical treatment.Material and methods. This retrospective study included 149 patients with MCO caused by both primary colon tumors and secondary compression or extra-colon tumors. All patients underwent X-ray guided colonic stenting in the N.N. Blokhin National Medical Research Center of Oncology between 2013 and 2017.Results. Primary technical success was achieved in 143 (96 %) patients, whereas overall technical success (including restenting) was achieved in 144 (96.6 %) patients. A total of 121 (84 %) patients demonstrated complete clinical success, while 23 (15.98 %) patients had partial clinical success. The efficacy of stenting was significantly higher in patients with primary colorectal cancer than in patients with secondary lesions of the colon (96.7 % vs. 27.3 %; p <0.0001).Conclusion. Stenting is a safe and effective method of comprehensive treatment for patients with colon cancer and signs of MCO. It expands the scope of palliative care for disseminated cancer. However, in patients with extra-organ compression and secondary lesions of the colon, this procedure remains largely ineffective.

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Current management of acute malignant large bowel obstruction: a systematic review

Cited by 185 publications

References 70 publications

Colonic cancer: The current role of stent insertion

Colonic cancer: The current role of stent insertion

Outcome of endoscopic self-expandable metal stents in acute malignant colorectal obstruction at a tertiary center

Colorectal stenting in cancer patients

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