Promising results of a new treatment in patients with bowel obstruction in colorectal surgery

Fahim, Milad; Dijksman, Lea M.; Kessel, Charlotte S. van; Smeeing, Diederik P.J.; Braaksma, A.; Derksen, Wouter J.M.; Smits, Anke B.

doi:10.1016/j.ejso.2019.10.011

Cited by 7 publications

(9 citation statements)

References 23 publications

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“…Preoperative tumour symptoms were present in 98% of patients in the emergency cohort compared with 32% in the elective cohort. Early detection and treatment of symptoms that can lead to emergency surgery can be an effective strategy, as shown by a previous study in our hospital [20]. The strength of this study is the extensive dataset of the DCRA registry, which allowed us to perform detailed analysis.…”

Section: Discussionmentioning

confidence: 88%

“…The gradual decline of emergency surgery from 2009 to 2017 can be partly explained by the start of the national colorectal cancer‐screening programme in the Netherlands in 2014 and partly by implementing a new obstruction protocol in our hospital in 2016 [20]. This obstruction protocol is used to prevent emergency surgery due to bowel obstruction and delays the operation, providing time for prehabilitation prior to elective surgery.…”

Section: Discussionmentioning

confidence: 99%

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Increased long‐term mortality after emergency colon resections

Fahim

Dijksman

Nat³

et al. 2020

Colorectal Disease

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Aim Emergency surgery is a known predictor for 30day mortality. However, its relationship with long-term mortality is still a matter of debate. The aim of this study was to analyse the effect of emergency surgery compared with elective surgery on long-term survival. Method Data from the Dutch Colorectal Audit and the Dutch Cancer Centre registry of a large nonacademic teaching hospital were used to analyse outcomes of patients who underwent surgery for colon cancer from 2009 until 2017. Univariable and multivariable Cox regression were used to assess the effect of emergency surgery on long-term mortality with adjustment for patient, tumour and treatment characteristics. Results A total of 1139 patients with a median followup of 40 months (interquartile range 23-65 months) were included. Emergency surgery was performed in 158 patients (14%). The 5-year survival after emergency surgery was 46% compared with 72% after elective surgery. After adjusting for baseline differences there was an independent and significant association between emergency surgery and increased long-term mortality (hazard ratio 1.79, 95% CI 1.28-2.51, P = 0.001). Conclusion Emergency surgery for colon cancer seems to lead to a significantly increased risk of long-term mortality compared with elective surgery. Detection and treatment of early symptoms that can lead to emergency surgery might be the way forward.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Increased long‐term mortality after emergency colon resections

Fahim

Dijksman

Nat³

et al. 2020

Colorectal Disease

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“…The association between nutritional indicators and OCRC prognosis deserves attention. The nutritional status of CRC patients, especially those complicated with obstruction, has received increased attention in the first-line clinical practice, and nutritional therapy plays a key role in comprehensive treatment [ 30 , 31 ]. The nutritional status of patients is generally worse due to the presence of digestive tract obstruction symptoms, and their surgical tolerance, postoperative or post-treatment complication risk, recovery ability, and anti-infection ability are lower than those of patients without obstruction [ 9 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Modified Naples prognostic score for evaluating the prognosis of patients with obstructive colorectal cancer

Gu,

Deng,

Jiang

et al. 2023

BMC Cancer

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Background Inflammatory, immune, and nutritional status are key factors in obstructive colorectal cancer (OCRC). This study aims to investigate the value of modified Naples prognostic score (M-NPS) in evaluating OCRC prognosis. Methods A total of 196 OCRC patients were retrospectively analyzed to construct M-NPS based on serum albumin (ALB), total cholesterol (CHOL), neutrophil:lymphocyte ratio (NLR), and lymphocyte:monocyte ratio (LMR), and then they were divided into three groups. The Kaplan–Meier (KM) method and Cox proportional hazard regression analysis were performed for overall survival (OS) and disease-free survival (DFS) of OCRC patients. Results Patients with high M-NPS had worse OS and DFS (P = 0.0001, P = 0.0011). Multivariate COX analysis showed that M-NPS was an independent prognostic factor for OCRC patients. Patients in the M-NPS 2 group had significantly worse OS (hazard ratio [HR] = 4.930 (95% confidence interval [95% CI], 2.217–10.964), P < 0.001) and DFS (HR = 3.508 (95% CI, 1.691–7.277), P < 0.001) than those in the 0 group. Conclusion M-NPS was an independent prognostic factor for OCRC patients; it might provide a potential reference for immunonutritional intervention in patients with obstruction.

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“…In the senior patient these measures that can enhance nutritional and physical condition can make an important difference. Promising results have been shown in a pilot study and are now further investigated in a multicenter setting [74].…”

Section: Emergency Surgerymentioning

confidence: 90%

“…Another alternative to emergency surgery is the obstruction protocol, which has been developed by some of the authors (M.F., A.S.) [74]. (Fig.…”

Section: Emergency Surgerymentioning

confidence: 99%