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Predictors for success of non-operative management of adhesive small bowel obstruction

World Journal of Gastrointestinal Surgery 2023年第6期15卷 1116-1124页

作者： Zi Qin Ng Vivien Hsu William Wei Han Tee Jih Huei Tan ruwan wijesuriya Department of General Surgery St John of God Midland HospitalMidland 6056Western AustraliaAustralia Department of Radiology St John of God Midland HospitalMidland 6056Western AustraliaAustralia Department of General Surgery Hospital Sultanah AminahJohor Bahru 80000JohorMalaysia

BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed ***,a proportion of patients failed non-operative *** To evaluate the predictors of successful non-operative management in adhesive *** A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May *** collated included basic demographics,clinical presentation,biochemistry and imaging results and management *** imaging studies were independently analyzed by a radiologist who was blinded to the clinical *** patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for *** Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both *** tests of inflammatory markers and lactate levels were similar in both *** the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical *** patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.

关键词： Small bowel obstruction Adhesive Conservative Non-operative

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Proximal and distal rectal cancers differ in curative resectability and local recurrence

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World Journal of Gastrointestinal Surgery 2011年第8期3卷 113-118页

作者： Wasantha Wijenayake Mahendra Perera Jayantha Balawardena Raeed Deen S ruwan wijesuriya Sumudu K Kumarage Kemal I Deen Department of Surgery National Hospital Department of Oncology National Cancer Institute Maharagama Sri Lanka Department of Surgery University of Kelaniya Medical School

AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum -those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without pre-operative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour-free margins, resection with a tumour-free circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.

关键词： Rectal cancer Pre-operative chemoradiation Inter-sphincteric resection Local recurrence Survival

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