Role of self expandable stents in management of colorectal cancers

Acute malignant colorectal obstruction is a complication of colorectal cancer that can occur in 7%-29% of patients. Self-expanding metallic stent placement for malignant colorectal obstruction has gained popularity as a safe and effective procedure for relieving obstruction. This technique can be used in the palliation of malignant colorectal obstruction, as a bridge to elective surgery for resectable colorectal cancers, palliation of extracolonic malignant obstruction, and for nonmalignant etiologies such as anastomotic strictures, Crohn's disease, radiation therapy, and diverticular diseases. Self-expanding metallic stent has its own advantages and disadvantages over the surgery in these indications. During the insertion of the self-expanding metallic stent, and in the followup, short term and long term morbidities should be kept in mind. The most important complications of the stents are perforation, stent obstruction, stent migration, and bleeding. Additionally, given the high risk of perforation, if a patient is treated or being considered fortreatmentwith antiangiogenic agents such as bevacizumab, it is not recommended to use self-expanding metallic stent as a palliative treatment for obstruction. Therefore, there is a need for careful clinical evaluation for each patient who is a candidate for this procedure. The purpose of this review was to evaluate self-expanding metallic stent in the management of the obstruction of the colon due to the colorectal and extracolonic obstruction.

Prognostic efficacy of inflammation-based markers in patients with curative colorectal cancer resection

AIM To evaluate the prognostic significance of neutrophilto-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR), and prognostic nutritional index(PNI) and other clinicopathological factors in patients undergoing curative resection of colon cancer.METHODS183 patients with histologically proven colorectal cancer who had undergone potentially curative resection between 2010 and 2016 at Ankara Numune Training and Research Hospital were retrospectively analyzed and clinicopathological characteristics included age, sex, tumor type, grade, size and localization, the number of metastatic and total number of lymph nodes removed, vascular and perineural invasion of the tumor, TNM stages, tumor marker levels(CEA, CA19-9, AFP, CA-125, CA15-3), complete blood counts, albumin levels, overall survival(months), NLR, PLR, LMR and PNI ratios were retrospectively reviewed and analyzed from the electronic database. The primary outcome measure was overall survival.RESULTS Regarding overall survival, on univariate analysis the following variables were significantly associated with poor outcome following resection: T-stage(P = 0.037), lymph node invasion(P = 0.037), cancer stage(P = 0.034), CEA(P = 0.042), CA19-9(P = 0.004), and PNI(P = 0.001). To evaluate the independent prognostic value, multivariate Cox proportional hazard analysis to control for other prognostic factors was used. Using cancer-specific death as an end point for NLR, PLR, LMR, PNI and CA19-9 the optimal cut off values were calculated by ROC analysis. Regarding overall survival, on multivariate analysis high CA19-9(HR = 1.001, 95%CI: 1.00-1.002, P = 0.012) and low PNI(HR = 0.938, 95%CI: 0.891-0.987, P = 0.014) were the only variables independently associated with shortened overall survival. Patients with a PNI < 35 had a median OS of 52.25 mo. In contrast, patients with an PNI > 35 had a median OS of 66 mo. Patients with a CA 19-9 < 17 had a median OS of 66 mo and in patients with a CA19-9 > 17 had a median OS of 53.76 mo.CONCLUSION This study shows that decrease in the PNI and increase in CA 19-9 is associated with poor survival in patients with resectable colon cancer.

Clinical course of percutaneous cholecystostomies:A crosssectional study

BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19 To in critical and elderly patients.Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,Ⅱ or Ⅲ AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45 (54.9%) were male,and the median age was 76 (35-98)years.According to TG18,25 patients (30.5%) had Grade Ⅰ,34 (41.5%) Grade Ⅱ,and 23 (28%) Grade Ⅲ AC.The American Society of Anesthesiologists (ASA)physical status score was Ⅲ or more in 78 patients (95.%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score (P=0.0001) and WBCC (P=0.025).Two months after discharge,two patients (3%) were readmitted with AC,and the intervention was repeated.Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC.The median follow-up time of these patients was 128 (12-365) wk,and their median lifetime was 36 (1-332) wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.