Colonic Self-Expandable Metallic Stents for Patients with Colorectal Cancer Obstruction Induced Sepsis
Journal of Surgery
Volume 5, Issue 3, June 2017, Pages: 53-57
Received: Apr. 6, 2017; Accepted: Apr. 27, 2017; Published: Jun. 22, 2017
Views 1989      Downloads 102
Authors
Heng Fan, Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
Jian-hua Zhu, Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
Article Tools
Follow on us
Abstract
To determine whether using colonic self-expandable metallic stents (SEMS) as a bridge to surgery for patients with colorectal cancer obstruction induced sepsis (CRCOIS) have better health outcomes compared with emergency surgery (ES). The patients with CRCOIS were enrolled from three university hospitals in China and retrospectively divided into SEMS group (n=32) or ES group (n=20). A total of 52 patients met the inclusion criteria. SEMS group had less the incidence of deep vein thrombosis (P<0.01) and number of organ dysfunction (P<0.01) than ES group. Kaplan-Meier curve showed no significant difference is found in term of 360-day overall survival between the two groups (log-rank test, P = 0.12). However, Multivariable analysis showed the pathological stages (OR: 1.26, 95%CI: 0.72-1.63, P<0.01) and number of organ failure (OR: 0.95, 95%CI: 0.71-1.42, P<0.01) are independent risk factors for 360-day overall survival. Therefore, SEMS placement as a bridge to surgery followed by selective surgery is a feasible and safe procedure for patients with CRCOIS, provides significant advantages of prognosis such as reducing the length of hospital stay, and decreasing the incidence of deep venous thrombosis and organ dysfunction.
Keywords
Self-expandable Metallic Stents, Colorectal Cancer Obstruction, Sepsis, Emergency Surgery
To cite this article
Heng Fan, Jian-hua Zhu, Colonic Self-Expandable Metallic Stents for Patients with Colorectal Cancer Obstruction Induced Sepsis, Journal of Surgery. Vol. 5, No. 3, 2017, pp. 53-57. doi: 10.11648/j.js.20170503.14
Copyright
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007, 18: 581–92.
[2]
Xu M, Chen YM, Huang J, Fang YJ, Huang WQ, Yan B, Lu MS, Pan ZZ, Zhang CX. Flavonoid intake from vegetables and fruits is inversely associated with colorectal cancer risk: a case-control study in China. Br J Nutr. 2016, 116: 1275-87.
[3]
Bertelsen CA, Neuenschwander AU, Jansen JE, Kirkegaard-Klitbo A, Tenma JR, Wilhelmsen M, Rasmussen LA, Jepsen LV, Kristensen B, Gögenur I; Copenhagen Complete Mesocolic Excision Study (COMES); Danish Colorectal Cancer Group (DCCG). Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery. Br J Surg. 2016, 103: 581-9.
[4]
Hsu CW, Wang JH, Kung YH, Chang MC. What is the predictor of surgical mortality in adult colorectal perforation? The clinical characteristics and results of a multivariate logistic regression analysis. Surg Today. 2016 Sep 20. [Epub ahead of print].
[5]
Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ. Preoperative Leukocytosis in Colorectal Cancer Patients. J Am Coll Surg. 2015, 221: 207-14.
[6]
Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig. 1991, 3: 1507–12.
[7]
Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011, 9: CD007378.
[8]
Tan CJ, Dasari BVM, Gardiner K. Systematic review and meta-analysis of randomised clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012, 99: 469–76.
[9]
Kavanagh DO, Nolan B, Judge C, Hyland JM, Mulcahy HE, O’Connell PR, et al. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum. 2013, 56: 433–40.
[10]
Mackay CD, Craig W, Hussey JK, Loudon MA. Self-expanding metallic stents for large bowel obstruction. Br J Surg. 2011, 98: 1625–9.
[11]
Kochanek M, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Böll B. Sepsis: new findings and developments. Update 2016. Dtsch Med Wochenschr. 2016, 141: 1455-8.
[12]
Greene NM. An A. S. A. (American Society of Anesthesiologists) Overseas Teaching Program. Anesthesiology. 1990, 72: 1-2.
[13]
Mira JC, Gentile LF, Mathias BJ, Efron PA, Brakenridge SC, Mohr AM, Moore FA, Moldawer LL. Sepsis Pathophysiology, Chronic Critical Illness, and Persistent Inflammation -Immunosuppression and Catabolism Syndrome. Crit Care Med. 2016 Sep 14. [Epub ahead of print].
[14]
Dastur JK, Forshaw MJ, Modarai B, Solkar MM, Raymond T, Parker MC. Comparison of short- and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol. 2008, 12: 51–5.
[15]
Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg. 2009, 33: 1281- 6.
[16]
Cirocchi R, Farinella E, Trastulli S, Desiderio J, Listorti C, Boselli C, Parisi A, Noya G, Sagar J. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013, 22: 14-21.
[17]
Ho KM, Chan KM, Kwok SY, Lau PY. Colonic self-expanding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review. Surg Endosc. 2016 Sep 8. [Epub ahead of print].
[18]
Testini M, Margari A, Amoruso M, et al. The dehiscence of colorectal anastomoses: the risk factors. Ann Ital Chir. 2000, 71: 433–40.
[19]
Morse BC, Simpson JP, Jones YR, Johnson BL, Knott BM, Kotrady JA. Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg. 2013, 206: 950-5.
[20]
Saida Y, Enomoto T, Takabayashi K, Otsuji A, Nakamura Y, Nagao J, et al. Outcome of 141 cases of self-expandable metallic stent placements for malignant and benign colorectal strictures in a single center. Surg Endosc. 2011, 25: 1748–52.
[21]
van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA, Dutch Stent-In Study Group. Premature closure of the Dutch Stent-in I study. Lancet. 2006, 368: 1573–4.
[22]
van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011, 12: 344-52.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186