Surgical emergencies in oncology

Bosscher, Marianne Roberta Frederiek; Leeuwen, Barbara L. van; Hoekstra, Harald J.

doi:10.1016/j.ctrv.2014.05.005

Cited by 31 publications

(22 citation statements)

References 99 publications

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“…Obstruction is the most frequent oncologic emergency seen in surgical practice [ 9 ]. In this study, of all patients with surgical oncologic emergencies, 42% had symptoms of obstruction with either malignant or benign origin.…”

Section: Discussionmentioning

confidence: 99%

“…Non-elective consultation for symptoms caused by malignant disease is an important marker of poor prognosis [ 3 – 8 ]. For some oncologic emergencies, surgical interventions may be necessary for dissolution or temporary relieve [ 9 ]. Not all cancer patients will benefit from surgery.…”

Section: Introductionmentioning

confidence: 99%

“…It is hardly possible to draught guidelines for the management of surgical oncologic emergencies. The great inter-patient variability and an even greater variety of influencing factors require that every patient needs to be evaluated individually [ 9 ]. In the absence of these guidelines, the most optimal method for objective evaluation and decision making would be discussion in a multidisciplinary cancer conference (MCC) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the absence of these guidelines, the most optimal method for objective evaluation and decision making would be discussion in a multidisciplinary cancer conference (MCC) [ 10 ]. It is essential to define the prognosis of both the emergency and the cancer stage, and taking into account the patient’s performance score when deciding on the treatment [ 9 , 11 ]. The most appropriate therapy is the treatment that has clinical benefit, and does not reduce the quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Current Management of Surgical Oncologic Emergencies

2015

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ObjectivesFor some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.MethodA prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.ResultsIn total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.ConclusionIn most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current Management of Surgical Oncologic Emergencies

2015

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“… 1 Surgical procedures may be necessary as a (temporary) remedy. 2 The clinical outcome of patients with surgical oncologic emergencies is often poor and the short-term mortality is high. 3 – 7 Surgical treatment can have severe complications and diminish end-of-life quality.…”

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confidence: 99%

Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies

et al. 2015

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BackgroundThe clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies.MethodsThis was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality.ResultsDuring the study period, 207 patients experienced surgical oncologic emergencies—101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19–92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002).ConclusionsDefining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.

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Temporary abdominal closure in oncological patients: Surgical characteristics and implications

Szor,

Pinto,

Obregon

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesIn critically ill patients, temporary abdominal closure (TAC) is utilized for conditions like abdominal compartment syndrome risk, gross abdominal contamination, and intestinal loop viability doubts. TAC techniques aim to safeguard abdominal contents, drain intraperitoneal fluids, and minimize fascia and skin damage. Our goal is to outline clinical characteristics and surgical outcomes in oncological patients undergoing peritoneostomy.MethodsPatients undergoing TAC with vacuum therapy at a tertiary oncological center were studied, with data sourced from an institutional database.ResultsForty‐seven patients (54.3% female), with an average age of 63.1 ± 12.3 years, were included in the study. The primary tumor site was predominantly gastrointestinal (78.2%). Patients presented systemic signs of chronic disease, reflected by a mean body mass index of 18.2 ± 7.6 kg/m², hemoglobin level of 9.2 ± 1.8 g/dL, and albumin level of 2.3 ± 0.6 g/dL. Additionally, most patients had a low‐performance status (53% Eastern Cooperative Oncology Group 1/2, 44.8% Karnofsky score ≤80, and 61.2% Charlson Comorbidity Index ≥6). Emergency surgical complications were the main reasons for initial surgery (68%), with the majority attributed to fecal peritonitis (65.9%). Only 14.8% of patients achieved complete abdominal closure with an average of 24.8 days until closure. The in‐hospital mortality rate was 85.2%.ConclusionTAC is an alternative for oncological patients with surgical complications, but it carries a high mortality rate due to the compromised conditions of the patients.

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Surgical emergencies in oncology

Cited by 31 publications

References 99 publications

Current Management of Surgical Oncologic Emergencies

Current Management of Surgical Oncologic Emergencies

Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies

Temporary abdominal closure in oncological patients: Surgical characteristics and implications

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