Long-term survival analysis after endoscopic stenting as a bridge to surgery for malignant colorectal obstruction: comparison with emergency diverting colostomy

The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. Objective: In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery. Methods: This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group.. Results: The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center. Conclusions: No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.

Carcinoma linfoepitelial de parótida / Lymphoepithelial carcinoma of the parotid gland

Carcinomas linfoepiteliais (LEC) são responsáveis poraproximadamente 0,4% dos tumores malignos da glândulasalivar, sendo uma variante do carcinoma indiferenciado comcaracterístico estroma linfoide denso. Existe forte associaçãoentre a lesão e a infecção pelo vírus Epstein Barr (EBV).Apresentamos o caso de um paciente do gênero masculino, 42anos, com abaulamento em região parotídea esquerda de cercade 6 cm, com crescimento lento e progressivo. Foi realizadaparotidectomia total. O diagnóstico anatomopatológico foi deneoplasia linfoepitelial parotídea multinodular. O tratamentocirúrgico associado à radioterapia pós-operatória é o principaltratamento empregado para LEC das glândulas salivares maiores.Recomenda-se radioterapia pós-operatória do leito tumoral e dopescoço ipsilateral porque LEC são altamente radiossensíveise a radioterapia pode erradicar a doença residual microscópicacompletamente. Esvaziamento cervical é reservado para ospacientes que apresentam linfonodos cervicais clinicamenteevidentes.

Lymphoepithelial carcinomaa (LEC) are responsible forapproximately 0.4% of malignant tumors of the salivary glandand are a variant of undifferentiated carcinoma with characteristicdense lymphoid stroma. A strong association has beendemonstrated between the lesion and Epstein Barr Virus (EBV)infection. We present a case of a 42 years-old man with bulgingin the left parotid region of about 6 cm with slow and progressivegrowing. Total parotidectomy was performed. The pathologicaldiagnosis was multinodular parotid lymphoepithelial neoplasm.The surgical treatment associated with postoperative radiotherapyis the main treatment for LEC of the salivary glands. Postoperativeradiation therapy to the tumor bed and ipsilateral neck because isrecommended, since LEC are highly radiosensitive, and radiationtherapy can completely eradicate microscopic residual disease.Neck dissection is reserved for patients who have clinically evidentcervical lymph nodes.