Postoperative infectious complications have a negative oncological impact in patients after stent placement with malignant large bowel obstruction

Matsuda, Akihisa; Yamada, Takeshi; Takahashi, Goro; Matsumoto, Satoshi; Yokoyama, Yoshihiko; Sonoda, Hiromichi; Ohta, Ryo; Shinji, Seiichi; Sekiguchi, Kumiko; Kuriyama, Satoru; Kanaka, Shintaro; Yoshida, Hiroshi

doi:10.1007/s00384-022-04290-9

Cited by 3 publications

(2 citation statements)

References 48 publications

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“…Complications may occur in less than 5% of cases, including bleeding, perforation, migration and obstruction. Given that stenting takes place under endoscopic and fluoroscopic guidance, sufficient experience in both colonoscopy and fluoroscopy is needed[ 32 , 48 ].…”

Section: Managementmentioning

confidence: 99%

“…Plain abdominal radiogram after stenting is necessary to assess the stent position and to exclude perforation based on the absence of intraabdominal free-air[ 48 , 79 ]. A multicenter retrospective study conducted in Japan including 129 patients with therapeutic surgery after stenting found that patients with postoperative infection had worse oncological outcomes, affecting relapse-free survival[ 48 ]. While the short-term outcomes are well studied and not conflicting, the long-term oncological outcomes remain unclear[ 13 , 32 , 80 ].…”

Section: Managementmentioning

confidence: 99%

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Management of obstructed colorectal carcinoma in an emergency setting: An update

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced (stage II, III or even IV). Diagnosis is based on clinical presentation, plain abdominal radiogram, computed tomography (CT), CT colonography and positron emission tomography/CT. The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes remains unknown. For the most common left-sided obstruction, the first choice should be either emergency surgery or endoscopic decompression by self-expendable metal stents or tubes. The operative plan should be either one-stage or two-stage resection. One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma (colostomy or ileostomy). Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity. Two-stage resection (Hartmann’s procedure) is safer and the most widely used despite temporally affecting quality of life. Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing. For the less common right-sided obstruction, one-stage surgical resection is more beneficial than endoscopic decompression. The role of minimally invasive surgery (laparoscopic or robotic) is a subject of debate. Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rupture and subsequent septic complications. The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates. Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes. Management plans are crucial and must be individualized to better fit each case.

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Section: Managementmentioning

confidence: 99%