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Objective@#To explore the short-term efficacy and prognosis of palliative surgical treatment for malignant bowel obstruction (MBO) caused by peritoneal metastasis of colorectal cancer (mCRC).@*Methods@#A retrospective cohort study was conducted. The inclusion criteria for patients were as follows: (1) primary colorectal cancer; (2) massive peritoneal metastasis; (3)obstructive site located below Treitz ligament by imaging; (4) obstruction refractory to conservative treatment; (5) estimated rese survival time more than 2 months; (6) patients and their families had strong willingness for operation; (7) surgical treatment included stoma/bypass and debulking surgery. In accordance with the above criteria, clinicopathological data of 46 patients undergoing palliative surgery at Peking University Gastrointestinal Cancer Center, Unit III from January 2016 to October 2018 were retrospectively collected. Postoperative symptomatic relief rate, morbidity of complication within 30 days, complication classification (Clavien-Dindo classification), mortality and survival after operation were analyzed. Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors.@*Results@#Among 46 patients, 30 were male and 16 were female with median age of 63 (19-87) years; 23 patients received stoma/bypass surgery (stoma/bypass group), and 23 cases received tumor debulking surgery (debulking group). The overall symptom relief rate was 76.1% (35/46), while symptom relief rate in the debulking group was 91.3% (21/23), which was significantly higher than 60.9% (14/23) in the stoma/bypass group (χ2=4.301, P=0.038). Postoperative complications occurred in 25 patients. The complication rate was 52.2% (12/23) in the debulking group and 56.5% (13/23) in the stoma/bypass group, without statistically significant difference (χ2=0.088, P=0.767). Morbidity of complication beyond grade III was 8.7% (2/23) and 13.0% (3/23) in the debulking group and stoma/bypass group respectively, without statistically significant difference (χ2=0.224, P=0.636). Four patients died within 30 days after operation, 2 (8.7%) in each group. Twenty-four patients underwent 1-8 cycles of chemotherapy ± targeting therapy (regimens: CapeOX ± Bevacizumab, FOLFOX/FOLFIRI ± Bevacizumab/Cetuximab), including 10 cases in the stoma/bypass group and 14 cases in the debulking group. Two patients of debulking group received postoperative radiotherapy and chemotherapy (50.6 Gy/22 f, with concurrent oral capecitabine). Till the last follow up of April 2019, 34 patients died (34/46, 73.9%) with a median overall survival time of 6.4 months, and the 6-month and 1-year survival rate was 54.5% and 29.2% respectively. The median survival time in the debulking group was significantly longer than that in the stoma/bypass group (11.5 months vs. 5.2 months, χ2=5.117, P=0.024). The median survival time of the 35 patients with symptomatic relief after operation was significant longer than that of 11 patients without relief (7.1 months vs 5.1 months, χ2=3.844, P=0.050). Multivariate analysis showed stoma/bypass surgery (HR=2.917, 95%CI:1.357-6.269, P=0.006) and greater omental metastasis (HR=4.060, 95%CI:1.419-11.617, P=0.009) were independent risk factors associated with prognosis of patients with MBO caused by peritoneal mCRC.@*Conclusions@#For patients of MBO caused by peritoneal mCRC, tumor debulking surgery may achieve higher symptom relief rate and prolong survival. Greater omental metastasis indicates poor prognosis.
ABSTRACT
Objective To investigate the clinical value of the transluminal radiofrequency catheter ablation (RFCA) for malignant esophageal obstruction.Methods The retrospective cross-sectional descriptive study was conducted.The clinicopathological data of 52 patients with malignant esophageal obstruction who underwent transluminal RFCA at the Affiliated Hospital of Shandong Academy of Medical Science between March 2013 and March 2016 were collected.Patients received the bipolar radiofrequency ablation (RFA) under dualchannel endoscopy and X-ray.Observation indicators:(1) intra-and post-operative situations:operation situations,operation time,time of RFA,postoperative complications and duration of postoperative hospital stay,(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the subsequent treatment,survival of patients and recurrence of esophageal obstruction up to June 2016.Measurement data with normal distribution were represented as average (range).Results (1) Intra-and post-operative situations:52 patients underwent successful RFCA,without the occurrence of aspiration,asphyxia,hemorrhage and perforation.Esophageal obstruction was disappeared after treatment,X-ray findings showed a smooth esophagus.Average operation time and time of RFCA were respectively 58 minutes (range,20-71 minutes) and 23 minutes (range,8-42 minutes).Patients took liquid food at postoperative day 2 and normal food at postoperative day 3,without the sensations of esophageal obstruction.Of 52 patients,1 with postoperative hypotension returned to normal level through rehydration and increasing blood volume.Five patients with postoperative substernal pain were improved after 2-day symptomatic treatment.And other 46 patients didn't have postoperative complications.Average duration of postoperative hospital stay was 3 days (range,1-5 days).(2)Follow-up:52 patients were followed up for 3-24 months,with a median time of 13 months.Of 52 patients,17 underwent single intravascular interventional therapy,15 underwent intravascular interventional therapy combined with single systemic chemotherapy,14 underwent single systemic chemotherapy and other 6 didn't undergo antineoplastic therapy.During the follow-up,9 patients didn't have esophageal obstruction and 26 were complicated with esophageal obstruction again.Esophageal obstruction of 26 patients was respectively occurred at 3-8 months postoperatively,20 patients were improved after bipolar transluminal RFCA under dual-channel endoscopy and X-ray and 6 received parenteral nutrition support therapy due to extreme exhaustion.Seventeen patients died of cachexia caused by terminal malignant tumors.Conclusion Transluminal RFCA is safe and effective for malignant esophageal obstruction,with a good short-term outcome.
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BACKGROUND/AIMS: White bile is colorless, translucent fluid found occasionally in malignant bile duct obstruction (MBO). Little information is available on the cause and effect of white bile. The aim of this study was to determine the frequency and clinical significance of white bile in MBO. METHODS: Bile was aspirated during endoscopic retrograde cholangiopancreatography in consecutive patients with MBO. White bile was defined as bile bilirubin or=1.5 mg/dL in the bile. Two groups were compared prospectively for the duration of jaundice, itching, cholangitis, level of obstruction, and decremental rate of bilirubin after the insertion of 7 Fr endoscopic nasobiliary drainage until the insertion of metal stent or 10 Fr plastic stent. RESULTS: Among 60 patients with MBO, 16 (26.7%) had white bile. WBC count in blood was higher (9,456/mm3 vs. 7,400/mm3, p=0.029) and cholangitis was more common (11/16 vs. 7/44, p=0.000) in white than yellow bile group. Proximal portion of MBO had no communication with GB in 9/16 patients with white bile group and 17/44 patients with yellow bile group (p>0.05). Mean survival of the inoperable 35 patients was 242 days in yellow bile and 227 days in white bile group (p>0.05). CONCLUSIONS: White bile in MBO was not rare and was associated with cholangitis. Gallbladder did not seem to play a role in the formation of white bile. Further study for the pathogenesis and prognosis of white bile in MBO will be necessary.