Document Detail


Defunctioning stoma in high ASA grade, aged patients, with bowel occlusion due to advanced cancer: is it still worthwhile?
MedLine Citation:
PMID:  20012907     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The aim of this study was to assess the role of defunctioning stoma (DS) in elderly high-risk patients with bowel obstruction from advanced colorectal cancer, by exploring consistent variables of outcome, because every other procedure was unfeasible. MATERIALS AND METHODS: A 6-year survey in a single surgery unit (between 1999 and 2004) was retrospectively evaluated, allowing to collect a cohort of 75 patients, aged over 65, who overall presented such critical condition. Pre-operatively, American Society of Anaesthesiologist grade classification was used. Post-operative course was monitored by focusing on gauging symptom relief. So, a validated assessment scale was employed to evaluate physical distress symptoms, graduated on a Likert scale and compared at baseline and day 7, on days 7 and 30, post-operatively. Length of hospital stay (LHS), morbidity, in-hospital (within 30 days) and overall mortality (within 6 months) were also assessed. Paired t test was used as statistical analysis to ascertain improvement of symptoms. RESULTS: All symptoms improved significantly (range, p < 0.05 to p < 0.01) within the surveyed time, with exception of vomiting on day 30 (p = 0.14). Average LHS was 22.8 (standard deviation, +/-3.856) days. Overall morbidity was detected in 68 (91%) patients. In-hospital and overall mortality rates accounted for 27 (35.8%) patients and for 48 (100%) patients, respectively. CONCLUSIONS: The role of DS was effective to improve symptom relief but was poor in terms of morbidity and mortality control. So, ethical concerns have to be addressed, and medical treatment or stenting for left-side obstructions only should be considered as alternative procedures.
Authors:
Corrado R Asteria; Gabriella Nesi; Chiara Minari; Paolo Vigan?
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Publication Detail:
Type:  Journal Article     Date:  2009-12-13
Journal Detail:
Title:  Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer     Volume:  18     ISSN:  1433-7339     ISO Abbreviation:  Support Care Cancer     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-02     Completed Date:  2010-05-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9302957     Medline TA:  Support Care Cancer     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  523-7     Citation Subset:  IM    
Affiliation:
Department of Surgery and Orthopaedics, Azienda Ospedaliera C Poma Mantua, Piazza 80th Fanteria 1, 46041 Asola, MN, Italy. corrado.asteria@libero.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Colorectal Neoplasms / mortality,  physiopathology,  surgery*
Data Collection
Female
Hospital Mortality
Humans
Intestinal Obstruction / etiology,  surgery*
Length of Stay
Male
Retrospective Studies
Risk Factors
Surgical Stomas*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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