Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.

Over a 30 year interval (1950 to 1979), 1,061 patients with colorectal carcinoma were seen; 148 presented with bowel obstruction and in this retrospective study were compared with those having nonobstructive tumors. The age and sex distribution did not differ between the groups. The curability rate was 53 percent, versus 72 percent for nonobstructed patients; the 5 year survival rate was 16 percent overall and 31 percent in curable cases, versus 37 and 50 percent for elective patients, respectively. Survival within tumor stages did not differ between the groups; the difference in outcome was mainly a result of obstructed patients having fewer stage A and more stage C lesions. Most right-sided growths were primarily resected, while the left-sided growths were mainly treated with staged resection. Operative mortality for curable patients was 8 percent, not different from the 7 percent rate in elective patients. The 5 year survival rate was 19 percent after primary and 35 percent after staged resection. It was concluded that patients with bowel obstruction secondary to colorectal carcinoma have low curability and survival rates, primarily because of advanced disease at the time of diagnosis and treatment.

Prognosis in patients with obstructing colorectal carcinoma.

Purpose Expandable metallic stent endoprosthesis for preoperative "bridge to surgery" treatment of obstructive colorectal cancer has been broadly, clinically used with good short-term results. Stent insertion for malignant tumor, however, is controversial because of the increased risk of metastasis, invasion, and advancement of the cancer. We, first in the world, evaluated the long-term prognosis of expandable metallic stent insertion compared with emergency surgery without expandable metallic stent. Methods Forty emergency operations (1986-1996) and 44 expandable metallic stent insertions (1993-2001) were retrospectively compared by history, duration, morbidity, and cumulative survival rate. Results There was no significant difference in age or lesion between the two groups. Postoperative complications were significantly less frequent in the expandable metallic stent group: wound infection was 14 vs. 2 percent; leakage following to anastomosis was 11 vs. 3 percent. Long-term prognosis did not significantly differ: three-year overall survival rate was 50 vs. 48 percent; five-year survival rate was 44 vs. 40 percent in the emergency operation and expandable metallic stent groups, respectively. Conclusion Because preoperative expandable metallic stent insertion for obstructive colorectal cancer had good postoperative results and no disadvantages in long-term prognosis, this procedure should be used in preoperative treatments of obstructive colorectal cancer.

Long-term prognosis of preoperative bridge to surgery expandable metallic stent insertion for obstructive colorectal cancer comparison with emergency operation

The surgical results in 127 cases of acute obstruction of the colon are presented. Carcinoma continues to account for the overwhelming number of cases, and there has been no appreciable change in the site of obstruction or age groups affected. In the current study, the overall mortality rate in patients with acute obstruction from all causes was 27 percent, which does not appear to be significantly different than it was 30 years ago. The overall mortality rate in patients with obstruction secondary to carcinoma was 23 percent. Under the specific circumstances of the cases reported herein, and on the basis of a limited experience, total colectomy and left colectomy as initial procedures in acute obstruction secondary to cancer had the same mortality rate as staged resection of the left colon. The only benefit found from either approach was an increase in the disease-free 5 year survival rate with staged resection. The overall survival rate was not enhanced by either approach.

Surgical management of the acutely obstructed colon. A review of 127 cases.

Intestinal obstruction owing to colonic carcinoma is a relatively frequent cause of acute abdominal pain. The aim of this prospective study is to evaluate the prognostic factors that may influence the final outcome of those patients operated upon for an intestinal obstruction (OG) as opposed to those electively operated upon (EG). From September 1984 to March 1988, a total of 188 patients with colorectal cancer have been included in the study. One hundred thirty-five were EG, while 53 (28.1 percent) were OG. The mean ages were similar in both groups. Sex, morbidity, and mortality rates were equally distributed. Curative resection rate was significantly higher in the EG group (P=0.029). Tumor staging tended to be significantly more advanced in OG patients (chi-square = 9.054;df=3;P=0.026). Multivariate analysis (proportional hazards model) showed that the only independent prognostic factor was tumor staging (P=0.0000). Obstruction itself disappears as a predictive variable when tumor staging is introduced in the model. We conclude that obstructing colon carcinomas tend to be more locally advanced, that probably being the only reason for a worse long-term prognosis.

Obstructing colorectal carcinomas. Prospective study.

The clinical courses of 68 patients with obstructive colonic cancers were reviewed. For the majority of patients with an acutely obstructing cancer of the left colon a conventional staged procedure remains the most appropriate treatment. Primary resection is suitable for the more proximal colonic cancer with obstruction. The operative mortality rate was 13.6 per cent, but with the addition of two nonoperative deaths, the figure rises to 16.2 per cent. Only six patients are known to have survived five years.

Obstructive colonic cancer

Femoro tibial bypass.

Histidine metabolism after portacaval shunt in the rat.

Immunoperoxidase method can be used to detect cellular or tissue CEA. Forty formalin-fixed paraffin-embedded specimens of colorectal carcinoma, 19 from patients who survived for five years after resection, and 21 from patients who died within five years were studied. Cellular CEA was present in 100 per cent of the specimens. Accurate quantitative evaluation of cellular CEA is currently not feasible. Therefore, the mere presence of cellular CEA has no prognostic value.

Tissue CEA in colorectal carcinoma

In the elderly, revascularization of a severely ischemic lower extremity with occlusion of both femoral and popliteal arteries often can be achieved by surgical construction of a distal bypass to the tibial or peroneal arteries. An aggressive diagnostic and therapeutic approach is necessary, in an attempt to prevent recourse to primary amputation. Femoroperoneal or femorotibial bypass can be performed safely and is recommended in elderly patients with advanced ischemia of a lower extremity with absolute indications for surgical intervention, e.g., gangrene, gangrenous ulceration or rest pain. A significant number of limbs can be salvaged by this method. Although the mortality rate in the older age groups is predictably higher, the overall rate for this operation compares favorably with that for primary amputation.

Femorotibial bypass in the elderly for revascularization of the severely ischemic lower extremity.

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