Palliative endoscopie therapy of rectal carcinoma

Dohmoto, M.; Hünerbein, M.; Schlag, P.M.

doi:10.1016/0959-8049(95)00486-6

Cited by 50 publications

(21 citation statements)

References 34 publications

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“…These may include endoscopic laser therapy such as the Nd:YAG (neodymium yttrium aluminium garnet) laser, cryotherapy, transanal resection, or photodynamic therapy. 25 Nd:YAG laser therapy can provide effective palliation in almost 90% of colorectal cancer cases with complication rates of less than 10% and with low treatment related mortality. 26 As our study showed that most patients with an unresected primary tumour and synchronous metastases did not develop major intestinal complications, an approach using initial chemotherapy alone, reserving endoscopic therapies for those patients who actually develop specific complications due to their primary tumour, is likely to be a feasible approach.…”

Section: Discussionmentioning

confidence: 99%

Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases

Tebbutt

2003

Gut

191

179

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Background: The role of palliative resection of the primary tumour in patients who present with metastatic colorectal cancer is unclear. Aims: This study compared the incidence of major intestinal complications in such patients who received chemotherapy treatment with or without prior palliative resection of the primary tumour. Patients: The incidence of intestinal obstruction, perforation, fistula formation, and gastrointestinal haemorrhage, and the requirement for abdominal radiotherapy in patients with metastatic colorectal cancer treated at a single institution over a 10 year period was determined. Results: Eighty two patients received initial treatment with chemotherapy without resection of the primary tumour (unresected group) and 280 patients had undergone prior resection (resected group). In the unresected group, the incidence of peritonitis, fistula formation, and intestinal haemorrhage was 2.4% (95% confidence interval (CI) 0.3-8.5%), 3.7% (95% CI 0.8-10.3%), and 3.7% (95% CI 0.8-10.3%), respectively, and was not significantly different from the resected group. Intestinal obstruction affected 13.4% (95% CI 6.9-22.7%) of patients in the unresected group and 13.2% (95% CI 9.2-17.2%) of patients in the resected group. More patients in the unresected group required >3 blood transfusions (14.6% v 7.5%; p=0.048) and abdominal radiotherapy (18.3% v 9.6%; p=0.03) than the resected group. Conclusions: The incidence of major intestinal complications in patients with unresected colorectal cancer and synchronous metastases who receive initial treatment with chemotherapy is low. Chemotherapy may be successfully used as initial treatment for such patients with no increased risk of most major intestinal complications compared with patients who have undergone initial resection of the primary tumour.

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Section: Discussionmentioning

confidence: 99%

Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases

Tebbutt

2003

Gut

191

179

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“…In 1991, Dohmoto first described the placement of self-expandable metal stents (SEMSs) as a palliative treatment [1], [2]. Hospitals in Japan started performing SEMS placement since January 2012, when this procedure became covered by the national health insurance system.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan

Nitta

Kataoka

Ohta

et al. 2017

Annals of Medicine &Amp; Surgery

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ObjectivesWe aimed to assess the efficacy of self-expanding metal stent (SEMS) implantation as palliative treatment for malignant colorectal obstruction.MethodsWe retrospectively reviewed the records of patients with malignant colorectal obstruction who underwent SEMS insertion as palliative treatment in our hospital between March 2013 and December 2016. We analyzed demographic, clinical, and operative characteristics.ResultsA total of 13 patients (8 males, 5 females; median age, 80.1 years) were reviewed. Tumor location included the left colon, rectum, and right colon in 38.5%, 38.5%, and 23% of the patients, respectively. Advanced and early colorectal cancer were noted in 7 (63.6%) and 4 (36.4%) cases, respectively. The mean ColoRectal Obstruction Scoring System score was 0.92 before stenting and 3.92 after stenting. Oral intake was resumed at a median of 2.1 days after SEMS placement. Median stent patency was 7.6 months, and 69.2% of patients maintained stent patency until death or the end of follow-up. Stent-related adverse effects included: re-occlusion (4 cases, 30.8%); stent migration (1 case, 7.7%), and pain with tenesmus (2 cases, 15.4%). In patients with re-occlusion (median follow-up interval, 1.3 months), stent patency was maintained for a median of 10.3 months (early failure, within 3 months; late failure, >11 months).ConclusionSEMS placement as a palliative treatment is likely to fail within a year, leading to re-occlusion. It is very important to maintain vigilant monitoring using X-ray, CT, and colonoscopy after SEMS placement, with close cooperation between the endoscopist and surgeon. A logistic framework involving careful follow-up, even in the absence of symptoms, and a combined team involving endoscopists and surgeons should be established to support re-intervention and surgery. We recommend vigilant monitoring of patients who received SEMS placement for palliation of malignant colorectal obstruction.

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“…Dohomoto first described SEMS placement in 1991 [2, 3]. Recently, there have been reports of colonic stents to relieve colonic obstruction, with the stents used as a bridge to surgery [4, 5].…”

Section: Discussionmentioning

confidence: 99%

Reocclusion after Self-Expandable Metallic Stent Placement for Relieving Malignant Colorectal Obstruction as a Palliative Treatment

Nitta¹,

Fujii²,

Hiratå

et al. 2016

Case Rep Gastroenterol

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Self-expandable metallic stent (SEMS) placement has been practiced in several hospitals in Japan, including ours, since January 2012. Here, we report the case of an 82-year-old Japanese man who presented to the hospital with a 1-week history of right hypochondrial pain. Computed tomography (CT) findings indicated colorectal cancer. The laboratory findings on admission indicated severe anemia (red blood cell count, 426 × 104/μL; hemoglobin, 7.9 g/dL). We performed SEMS placement because the patient refused to undergo surgery. He did not attend any of the scheduled follow-up visits after SEMS placement. However, a year and a half after the SEMS placement, the patient attended the hospital because of difficulty in passing stool. A plain abdominal CT scan showed bowel reobstruction due to the ascending colon cancer after SEMS placement. We performed an emergency operation, ascending colostomy, on the same day. Colorectal stent placement may be a good treatment option for patients who refuse to undergo conventional therapeutic treatments or in those with unresectable colorectal cancer. Patients should be carefully followed up every few months after SEMS placement because of the risk of reocclusion.

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Palliative endoscopie therapy of rectal carcinoma

Cited by 50 publications

References 34 publications

Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases

Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases

Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan

Reocclusion after Self-Expandable Metallic Stent Placement for Relieving Malignant Colorectal Obstruction as a Palliative Treatment

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