Palliative surgical outcome score (PSOS) in patients treated palliatively with self-expanding metal stent (SEMS) for malignant incurable colorectal obstruction

Søreide, Jon Arne; Tholfsen, Tore; Karlsen, Lars Normann; Kvaløy, Jan Terje; Kørner, Hartwig

doi:10.1016/j.suronc.2019.04.006

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…Herein, we were able to insert successfully the SEMS in 100% of patients owing to the good expertise of endoscopists, but with a clinical success in only 72.7% of cases. Such results are in agreement with other literature evidences, reporting technical success of 85%‐95% and clinical success of 70%‐85% 16‐18 . Of note, we would stress an original result of this investigation, as the clinical success was inversely correlated with NLR.…”

Section: Discussionsupporting

confidence: 93%

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Lovero

Losurdo

Fortezza

et al. 2020

Eur J Clin Investigation

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Background Acute obstructive colorectal cancer requires prompt decompression commonly by emergency surgery (ES). However, self‐expanding metal stents (SEMS) have been increasingly used as a bridge‐to‐surgery (BTS) strategy. Materials and methods In an 8‐year period, consecutive patients with acute left‐sided colonic obstruction, due to locally advanced colorectal cancer, underwent ES or SEMS implantation. We evaluated technical/clinical success of SEMS, adverse events, and overall (OS) and disease‐free survival (DFS) of the two therapeutic options. Results Forty‐five patients underwent ES (n = 23) or SEMS (n = 22). The two groups were comparable for sex, age, ASA score and cancer site/stage. Technical and clinical successes of SEMS were 100% and 72.7%, respectively. Clinical success correlated with neutrophil‐lymphocyte ratio (NLR) at baseline (OR = 0.65, 95% CI 0.43‐0.98, P = .04). SEMS allowed primary anastomosis in the 45.5% of cases (0% in ES). SEMS implantation allowed a higher rate of surgery carried out by a laparoscopic approach: 36.4% vs 13.0% in ES. Performance of a definitive stoma and complications were similar. Median OS (34 in SEMS; 45 in ES, P = .33) and DFS (36 in SEMS; 35 in ES, P = .35) did not differ between the two groups. At univariate analysis, DFS was positively associated with primary anastomosis (HR = 2.44, 95% CI 1.4‐16.6, P = .04) and laparoscopic surgery (HR = 8.33, 95% CI 1.08‐50, P = .04), and inversely associated with a NLR > 3.6 (HR = 0.59, 95% CI 0.16‐0.92, P = .03). At multivariate analysis, no feature retained an independent predictive power. Conclusion SEMS is an effective and safe procedure, equivalent to emergency surgery in terms of complications, OS and DFS, providing the chance of a primary anastomosis in the majority of patients.

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Section: Discussionsupporting

confidence: 93%

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Lovero

Losurdo

Fortezza

et al. 2020

Eur J Clin Investigation

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“…This is primarily due to the retrospective design of these often small, observational studies, the inherent selection bias, and the inconsistent definitions of palliative surgery, usually describing noncurative treatments without addressing the effects on symptom relief [34]. The palliative surgical outcome score (PSOS) was introduced to evaluate the impact of palliative surgical interventions and was recently assessed as a helpful instrument [35,36]. Recently, a more general model based on the time at home was proposed to measure the functional outcome after the resection of cancer [37].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and fate of patients with rectal cancer not entering a curative-intent treatment pathway: A complete nationwide registry cohort of 3,304 patients

Kørner

Guren

Larsen

et al. 2022

European Journal of Surgical Oncology

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“…Much work still needs to be done to determine if significant disparities in surgical palliative care outcomes exist across different populations. Most of the current surgical palliative care research invests in understanding its proper indications, innovating new ways to increase accessibility, and defining what outcomes matter (30,60,61). Because of the extensive healthcare disparities experienced throughout other fields of medicine, it is also important to recognize how surgical palliative care advances might disparately affect various at-risk groups such as rural populations, racial/ethnic minorities, and older adults.…”

Section: Evidence Gaps and Future Directions For Understanding Surgical Palliative Care Outcomes Disparitiesmentioning

confidence: 99%

Surgical palliative care disparities

Rowe

Johnston

2022

Ann Palliat Med

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Surgical palliative care is an interdisciplinary treatment modality that aims to decrease suffering and improve the quality of life of seriously ill surgical patients. Although surgical palliative care is increasingly being found to positively impact patient quality of life, disparities in surgical palliative care remain poorly defined. While the field of medical palliative care has demonstrated certain racial/ethnic, socioeconomic, and geographic groups are at higher risks for receiving worse palliative care, there is no analogous consensus in the field of surgical palliative care. This is largely secondary to a paucity of research focus in this field. Given that the aforementioned disparities experienced by minoritized patient populations has led to significant morbidity, it is important to understand and call attention to disparities existing within the field of surgical palliative care as well. To advance the knowledge of current healthcare shortcomings and progress towards equitable surgical palliative care, this paper reviews the current state of surgical palliative care disparities evidence, details gaps in knowledge, and highlights priorities for future surgical palliative care research. The articles identified in this review noted disparate surgical palliative care access and outcomes across various racial/ethnic groups, age ranges, socioeconomic classes, hospital populations, and regions. However, evidence scarcity necessitates more robust research be performed to adequately identify at risk groups and understand the factors supporting disparity development.

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Palliative surgical outcome score (PSOS) in patients treated palliatively with self-expanding metal stent (SEMS) for malignant incurable colorectal obstruction

Cited by 6 publications

References 25 publications

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Characteristics and fate of patients with rectal cancer not entering a curative-intent treatment pathway: A complete nationwide registry cohort of 3,304 patients

Surgical palliative care disparities

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