Malignant Obstruction Research Articles

Revisiting malignant gastric outlet obstruction: Where do we stand?

The scope of management of malignant gastric outlet obstruction is ever-expanding. The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes. With technical success rates close to 96%, stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents. Understanding the correct concept of palliation is the need of the hour in management. Identifying the right patient for palliation, selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care. Also, newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.

Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer.

Pancreatic cancer is associated with high rates of morbidity and mortality. Endoscopic ultrasound (EUS)-guided biopsy has become the standard diagnostic modality per the guidelines. The use of EUS has been growing for providing various treatments in patients with pancreatic cancers: biliary and gallbladder drainage for those with malignant biliary obstruction, gastroenterostomy for malignant gastric outlet obstruction, celiac plexus/ganglia neurolysis for pain control, radiofrequency ablation, placement of fiducial markers, and injection of local chemotherapeutic agents. In this review, we explore the recent clinical studies evaluating the EUS-guided treatments in pancreatic cancer.

Self-Expandable Metal Stents for Obstructing Colon Cancer and Extracolonic Cancer: A Review of Latest Evidence.

Colorectal cancer (CRC) is a leading cause of cancer mortality, with many patients presenting with malignant colorectal obstruction (MCO). Self-expandable metal stents (SEMSs) have emerged as a minimally invasive key intervention, both as a bridge to surgery (BTS) in curative setting sand for palliation in advanced disease. This review aims to provide an evidence-based analysis of SEMS indications, contraindications, and efficacy across curative and palliative contexts, with focus on long-term outcomes. Based on data from recent trials and guidelines, we examine SEMS placement outcomes, focusing on specific scenarios, including BTS for left-sided MCO, chemotherapy (with angiogenic agents) safety during stent therapy, the optimal timing between SEMS placement and surgery, and oncological outcomes. We also discuss the use of SEMSs in challenging contexts such as proximal colon obstruction and extracolonic obstruction, and the relevant technical considerations. Findings indicate that using a SEMS in the BTS setting reduces emergency surgery needs, minimizes complications, and decreases stoma formation. Long-term oncologic outcomes, particularly recurrence, are still debated, but recent evidence shows that SEMS placement is safe, without worsening long term outcomes. Palliative SEMS placement shows high efficacy in symptom relief with manageable adverse events. Success depends on patient selection and technical expertise, with multidisciplinary approaches essential for optimal outcomes.

Palliative endoscopic treatment of malignant central airway obstruction

PurposeTo examine the outcome of palliative endoscopic treatment of malignant central airway obstruction (CAO) and identify predictors for Days Alive and Out of Hospital (DAOH), overall survival and treatment related complications.MethodsConsecutive adult patients treated endoscopically for malignant CAO at Aarhus University Hospital from 2012 to 2022 were included in the study. Statistical analyses were carried out to identify predictors for DAOH, survival and complications.Results127 consecutive patients met the inclusion criteria. The majority of patients were categorised with stage IV lung cancer, the majority being males, with a median age of 67 years. The endoscopic interventions were mainly tumour debulking combined with airway stent insertion or tumour debulking alone. The complication rate was 21.0% and the mortality rate was 3.9%. In total, 89.8% of the patients experienced symptom relief following surgery, and the majority (92.1%) were discharged from hospital within two days after intervention. Mean survival time following intervention was 144 days, mean DAOH30 was 20.8 and mean DAOH365 was 157. Survival was associated with comorbidity, type of intervention, preoperative respiratory support and postoperative oncologic treatment. A high preoperative ASA-score, preoperative respiratory support, urgency of intervention, female gender and insertion of airway stent were predictors for a poorer DAOH-outcome.ConclusionEndoscopic palliative treatment of malignant CAO is generally feasible and safe, offering symptom relief in most cases. The method is considered an effective measure for short to median term palliation of respiratory distress.

Comparison of short-term outcomes of robotic and laparoscopic surgery for mid-low rectal cancer: a propensity matched analysis

Objective: To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer. Methods: This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients. Results: (1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant (P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups (P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ2 = 4.009, P = 0.044). Conclusion: In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications.

Adverse Events after Percutaneous Transhepatic Biliary Drainage: A Ten-Year Retrospective Analysis.

To determine the adverse events (AEs) rate associated with percutaneous transhepatic biliary drainage (PTBD) and identify risk factors for their occurrence. This single-center retrospective study included 2310 PTBD (right-side: 1164; left-sided: 966; bilateral: 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010-2020. Patients with percutaneous cholecystostomy alone were excluded. There were 455 initial drain placements (66 with cholangioplasty) and 1855 exchanges (202 with cholangioplasty). Stents were placed in 163 procedures (metal: 156; plastic: 86). Demographic and procedural variables were assessed using multivariable logistic regression. A total of 745 AEs were recorded. The three most common AEs were peri-catheter bile leak (331/745; 44.4%), catheter occlusion (110/745; 14.7%), and drain dislodgement (103/745; 13.8%). There was a significantly higher overall AE rate amongst patients with malignant biliary obstruction compared to benign [29.8% vs. 17.6%; p=0.0065; odds ratio (OR)=1.57(1.13-2.18)]. Intra-procedure cholangioplasty was associated with decreased AE rate for initial drains and overall procedures [OR=0.48 (0.25-0.90); p=0.02 and OR=0.63 (0.45-0.89); p=0.0092]. Finally, a right-sided drain was associated with an increased overall AE rate for initial drains and overall procedures [OR=1.62 (1.02-2.55); p=0.04 and OR=1.43 (1.05-1.91); p=0.02]. Malignant obstruction and right-sided drains are associated with a higher risk of PTBD-related AEs, while intra-procedure cholangioplasty reduces risk. These findings offer insights into how this high-impact procedure can be performed more safely and effectively.

Self-expanding metallic stent insertion for malignant bowel obstruction secondary to gynecologic malignancies: a retrospective analysis : SEMS for gynecological MBO is efficient.

Malignant bowel obstruction (MBO) is a common complication in advanced and recurrent gynecologic malignancies, with limited treatment options and poor prognosis. Self-expanding metallic stent (SEMS) insertion has emerged as an alternative palliative measure, yet data specific to gynecologic malignancies remains scarce. A retrospective analysis was conducted on 61 patients with gynecologic malignancies and malignant large bowel obstruction who underwent colorectal stenting between January 2002 and December 2023. Data, including demographics, procedural details, clinical outcomes, and complications, were collected from electronic medical records. The mean age of patients was 65.7years, with ovarian cancer being the most common malignancy (77%). "Technical success" of SEMS insertion was achieved in 91.4% of cases, with a "clinical success" rate of 76.7%. Major complications occurred in 2% and 5% of patients at 30- and 90days post-procedure, respectively. Overall mortality rates were 4% at 30days and 28% at 90days. SEMS for managing MBO is a promising alternative to surgery in patients with advanced or recurrent gynecologic malignancies. It offers high technical and clinical success rates with acceptable complication rates. Further research is needed to delineate optimal patient selection criteria and refine procedural techniques to maximize outcomes in this challenging population.

Initial experience of a novel ureteral silicon-covered metallic mesh stent in malignant ureteric obstruction: a single-center retrospective study

BackgroundThis study aimed to investigate initial experiences and outcomes of a retrograde inserted new silicone-covered metallic ureteric stent (Urexel™) for malignant ureteric obstruction.MethodsWe retrospectively reviewed the medical records for 12 consecutive patients who underwent Urexel™ stent placement for malignant ureteric obstruction from March 2020 to March 2021. The Urexel™ stent is a segmental metallic ureteric stent composed of a nitinol mesh covered with a silicone membrane. We evaluated the clinical outcomes and complications of this new metallic ureteric stent.ResultsThe median age of patients was 61.5 (44–82) years, and the median follow-up was 25.5 (4–37) months. One of the 12 patients underwent bilateral stent insertion, Urexel™ stents were placed in a total of 13 ureteral units. There was no technical failure during stent placement. The median length of obstructions was 9 (1–22) cm. Balloon dilation was necessary in 38.5% (5/13 ureter units) of cases. The 6-month success rate was 83.3%, 1-year success rate was 70%, and estimated success rate was 44.4% at 2-year. Encrustation, migration and hyperplasia were the cause of overall treatment failure in all 6 cases of failure, with median elapsed time to failure of 9.5 (1–30) months. Common complications included persistent pain, acute pyelonephritis, and lower urinary tract symptoms, but they were Clavien-Dindo grade I or II.ConclusionsIn this initial series of novel ureteral silicon-covered metallic mesh stents, Urexel™ provided acceptable success and complication rate in malignant ureteric obstructions.

The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios.

Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible. EUS-HGS, which allows biliary drainage by trans-gastric route, is primarily used for proximal stenosis or in case of surgically altered anatomy; EUS-CDS with Lumen-Apposing Metal Stent (LAMS) for distal MBO (dMBO), EUS-AS as an alternative of EUS-HGS in the bridge-to-surgery scenario or when retrograde access is not possible and EUS-guided gallbladder drainage (EUS-GBD) with LAMS in case of dMBO with cystic duct patent without dilation of common bile duct (CDB). EUS-guided gastroenterostomy (EUS-GE) has already established its role as an effective alternative to surgical GE and enteral self-expandable metal stent, providing relief from GOO with fewer complications and faster recovery times. However, we do not yet have strong evidence on how to combine the different EUS-guided drainage techniques with EUS-GE in the setting of double obstruction. This comprehensive review aims to synthesize growing evidence on this topic by randomized controlled trials, cohort studies, and case series not only to summarize the efficacy, safety, and technical aspects of these procedures but also to propose a treatment algorithm based essentially on the anatomy and stage of the neoplasm to guide clinical decision-making, incorporating the principles of personalized medicine. This review also highlights the transformative impact of EUS-guided interventions on the treatment landscape for MBO and GOO. These techniques offer safer and more effective options than traditional approaches, with the potential for widespread clinical adoption. Further research is needed to refine these procedures, expand their applications, and improve patient care and quality of life.

Thermal Ablation and Intralesional Cisplatin Injection as Adjunct to Systemic Chemotherapy in Managing Malignant Central Airway Obstruction: A Case Report

Endobronchialultrasound (EBUS)-guidedintralesional chemotherapy and thermal ablation using cryotherapy and electrocautery can be used for the management of malignant central airway obstruction (CAO). This is a case of a 62-year-old male presenting with cough, hoarseness, and shortness of breath. He was diagnosed with squamous cell carcinoma stage IVA (T4N2M1a), causing malignant CAO that progressed to impending respiratory failure (ECOG PS 4). Chest CT scan findings included a left main bronchus mass measuring 3.7 x 5.8 x 5.9 cm causing complete atelectasis, a right pleural-based mass, and osteolytic destruction of the 3rd lateral ribs. Bronchoscopy showed a fungating, friable mass in the carina extending to the orifice of the right and left mainstem bronchus with 70% and 100% occlusion, respectively. A multimodality treatment approach was taken with tumor debulking by thermal ablation with cryotherapy and electrocautery, EBUS-guided intralesional cisplatin, and systemic chemotherapy. Subsequently, there was an interval decrease in the size of the tumor in multiple areas, with left lung re-expansion. The clinical symptoms of the patient significantly improved and ECOG status increased to 1. No adverse effects were noted post procedure. Intralesional cisplatin can be an effective and safe adjunct treatment in malignant CAO, alongside thermal ablation and systemic chemotherapy.

Endoscopic Approaches for Managing Small Intestinal Disease.

The endoscopic evaluation and management of small intestinal diseases continue to evolve and expand. The advent of small bowel wireless capsule endoscopy and deep enteroscopy with either a double- or single-balloon enteroscope now allows complete endoscopic visualization of the entire small intestine and enables access for endoscopic interventions such as biopsies or hemostasis for most of the small bowel. New endoscopic techniques are available to treat proximal malignant small bowel obstruction, including intraluminal stents and endoscopic gastrojejunal stents. Emerging technologies also aim to improve weight loss and diabetes management via small bowel endoscopic interventions.

Endoscopic ultrasound guided-gastroenterostomy is the best choice in the treatment of gastric outlet obstruction.

First of all, I would like to congratulate Vilas-Boas et al on an interesting publication. In this letter the authors write about very interesting topics in the management of patients with malignant gastric outlet obstruction (GOO). GOO developed in up to 20% of patients with advanced hepatopancreatobiliary disease both in benign and malignant form. For this reason, the issue is very current. I fully agree with Vilas-Boas et al that technical aspect of the procedures (surgeon's view) often differs from the patient's view (regarding such factors as cancer-related survival, overall survival, body mass composition, nutritional biomarkers, chemotherapy tolerance and patient-reported quality of life). The mentioned factors should be taken into account when interpreting the effectiveness of treatment modalities for malignant GOO (mGOO), which should be also considered in the future studies in this subject. In my opinion, all above mentioned factors could be summarized in one term: "Improving quality of life of patients with mGOO".

A case of endoscopic colonic stenting for the malignant obstruction in the ileum end

A case of endoscopic colonic stenting for the malignant obstruction in the ileum end

Efficacy and safety of a novel multisegmented fully covered self-expanding metal stent for malignant esophageal obstruction: a prospective pilot study with historical control.

Self-expanding metal stents (SEMSs) are effective for symptom palliation in patients with esophageal obstruction. However, their placement can lead to adverse events such as stent migration and restenosis. A novel fully covered SEMS (FCSEMS) with antimigration properties has been developed to address these issues. This study aimed to evaluate the feasibility and safety of this novel stent in treating malignant esophageal obstruction. This prospective pilot study enrolled patients with malignant esophageal obstruction treated with the novel stent at a tertiary referral center. Primary outcomes included technical and clinical efficacy, whereas secondary outcomes were adverse events. Treatment outcomes were compared between the novel stent and historical control groups. 137 patients were analyzed, comprising 32 in the novel stent group and 105 in the historical control group. In the novel stent group, technical success was achieved in 100% of patients and clinical success in 96.9%. No stent placement-related events, including bleeding or perforation, were observed. Though no significant differences in adverse events were found, the novel stent group had a lower migration rate than the historical control group (9.4% vs. 14.3%, p = 0.565). Median stent patency was similar between the groups (70.5 vs. 43.0days, p = 0.185). The novel multisegmented FCSEMS demonstrated high technical and clinical efficacy with a low migration rate, presenting a promising treatment option for malignant esophageal obstruction. Further studies with larger samples are needed to confirm these findings.

Upper Limb Deep Venous Thrombosis Associated With Peripherally Inserted Central Catheters in Hospitalised Surgical Patients.

Introduction Surgical inpatients frequently require peripherally inserted central catheters (PICCs) for parenteral feeding and administration of medication. PICCs may cause upper limb deep venous thrombosis (ULDVT), which impacts patient morbidity. We investigated the risk and prevention of PICC-ULDVT in hospitalised surgical inpatients. Methods We conducted a retrospective analysis of 168 consecutive surgical inpatients who received a PICC over the same four-year period. Data from 136 additional consecutive general medical inpatients with PICCs over the same period were included for comparison. We observed and compared the incidence of ULDVT confirmed on dedicated upper limb venous imaging in the cohort of surgical patients compared to a time matched cohort of medical patients. We extracted data including patient demographics, details of admission, and insertion site of the PICC from the hospital electronic notes. Results The incidence of ULDVT in surgical patients was 4.7% compared to 1.5% in medical patients despite increased age (p=0.001) and comorbidity burden (p=0.001) in the latter group. Ninety percent of surgical patients had abdominal surgery within 30 days of PICC placement. Regression multivariate analysis identified concurrent cancer (p=0.048), median Charlson Comorbidity Index (CCI) (p=0.034), admission with malignant bowel obstruction (p=0.002), and catheter insertion into the brachial vein (p=0.033) as significant risk factors for PICC-ULDVT in hospitalised surgical patients. Standard pharmacological venous thromboembolic events (VTE) prophylaxis, as per national guidelines, did not reduce the risk of PICC-ULDVT. Conclusion Our study indicates that surgical inpatients are at greater risk of developing PICC-associated upper limb deep vein thrombosis (ULDVT) compared to medical inpatients, with limited evidence supporting the effectiveness of pharmacological thromboprophylaxis in reducing this risk. PICCs should be used with caution in patients with cancer, cancer-related bowel obstruction, and surgical patients with a higher comorbidity index. PICCs inserted via the basilic vein may reduce ULDVT risk, but further studies are needed on the preferential site of insertion in surgical patients.

Trends in Management of Malignant Bowel Obstructions: A Longitudinal Analysis of the National Inpatient Sample.

Malignant bowel obstructions (MBO) are complex, heterogeneous disease processes which can be managed with surgical or endoscopic interventions. Patients with MBO often have advanced metastatic disease and poor functional status, which makes it difficult for providers to determine the best treatment strategy. Patients with urgent or emergent admissions and a primary or secondary ICD-9/ICD-10 diagnosis of bowel obstruction with an additional diagnosis of disseminated cancer were identified from the National Inpatient Sample (2000-2017). Patients were stratified into operative and non-operative intervention groups. Multivariate regression determined factors associated with surgical treatment of MBO based on significant factors on univariate analysis. Trends in treatment over time were calculated using log-linear regression to determine the annual percent change (APC). Of 1118 patients, 18% underwent surgery and 7% underwent endoscopic intervention. From 2000 to 2017, a decreasing proportion of patients underwent surgery (APC -2.4, p = 0.023) with a commensurate increase in endoscopic interventions (APC 5.3, p = 0.042). There was also a decrease in the proportion of patients who died during hospitalization (APC -4.3, p = 0.029). Surgery was associated with longer mean lengths of stay (13 days vs. 7 days, p < 0.001) and higher rates of in-hospital mortality (13% vs. 6%, p = 0.001) compared to non-operative management. The proportion of patients receiving surgery for MBO is decreasing and that receiving endoscopic interventions is increasing. In-hospital mortality is also decreasing proportionately, suggesting an improvement in patient selection.

Correlation between liver volume drainage and clinical success after endoscopic biliary drainage of hilar malignant obstruction

Background and aimMalignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate. MethodsThe authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage. Results82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4–12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7–26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant. ConclusionDrainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.

Considerations in the Management Procedures of Malignant Large Bowel Obstruction; Surgical versus Conservative Management: Outcome and Prognostic Factors

Abstract Introduction Malignant obstruction of the large bowel is a common clinical presentation, particularly in terminal cancer patients. Urgent resection and surgical diversion were the treatments of choice. Objective The aim of the current study was to compare urgent resection of the colon and surgical diversion as conservative management in patients presented with malignant colorectal obstruction regarding short-term, post-operative, prognostic, and long-term oncologic outcomes. Methods 80 patients with clinical and/or radiological evidence of malignant bowel obstruction distal to the ligament of Treitz and patients presented with incurable primary intra-abdominal primary cancer and patients with intra-peritoneal disease were included in the study. Patients were divided into 2 groups. The first group included 20 patients (25%) who underwent conservative management, while 60 patients (75%) underwent definitive surgical management. Results We showed statistically significant findings between both groups regarding the total length of hospital stay, the total amount of costs, the rate, and the interval of re-admission. The duration of staying at hospital and rate of re-admission in the group that was managed by definitive surgery is more than the group of patients that was managed by conservation. We found that the rate of postoperative complications and morbidity in patients who underwent urgent definitive surgical resection was higher than that in those who underwent conservative management. Conclusion In patients with malignant obstruction of the colon selection of definitive surgical management might not improve patients' outcomes and conservative management in addition to chemotherapy might be superior and might improve patients' outcomes and survival.

The feasibility of the deep hypothermal cryotherapy plus immune checkpoint inhibitor for treatment of severe malignant central airway obstruction.

The recurrence shortly after interventional therapy poses a great challenge in managing malignant central airway obstruction (MCAO). While cryotherapy has shown potential benefits when combined with immunotherapy in lung cancer, its effectiveness for improving local control of malignant central airway tumors is not well understood. This study aims to evaluate the clinical efficacy and safety of combining these strategies. A total of 12 patients with MCAO who had been treated with a combination of cryotherapy and immune checkpoint inhibitors (ICIs) were compiled for analysis in a tertiary hospital in Shanghai East Hospital, China. The primary endpoint is the duration of efficacy (DoE) for MACO after the combined therapy, which was defined as the time interval of the airway stayed patency without additional repeated interventional treatment. Secondary endpoints encompassed an assessment of objective response rate, overall survival and the adverse events. Twelve patients received a combination therapy between January 2021 and December 2023. Median age was 66 years, 91.7% male. Fifty percent were squamous carcinoma. 50.0% had medium to low programmed cell death-ligand 1 (PD-L1) levels. 41.7% patients' performance status scored higher than 2. 91.7% (11/12) of the patients objectively respond to the combined therapy, with a median DoE of 10.0 (95% confidence interval: 3.7-21.7) months. The 6-, 12- and 18-month survival rate was 75.0%, 50.0% and 41.8%, respectively. The most common adverse event was granulation. Other events included mild rash, pneumonitis, and hypothyroidism. No severe procedure-related adverse events occurred. In patients with endoluminal or mixed MCAO, our findings suggest that combining endobronchial cryotherapy with ICIs may help maintain airway patency, offering a promising preliminary signal for this therapeutic approach.

Current state of surgery and trauma in Mauritania: a Scoping Review

Introduction: Nearly one-third of the global burden of disease can be addressed through surgical care. Trauma forms a significant part of this burden, resulting in higher mortality than HIV, tuberculosis, and malaria combined. Mauritania, one of the largest countries in West Africa, lags significantly behind the sustainable development goals set by the World Health Organization (WHO). In this study, we reviewed the available literature on surgery and trauma in Mauritania. Methods: We conducted a literature review using the Embase database (from 1974) and Medline (from 1946) up to June 2024. All studies related to surgery and trauma in Mauritania were included. Studies focused solely on obstetrics, gynaecology and anaesthesia were excluded. Articles were screened for eligibility using Rayyan software. Results: The search strategy returned 449 abstracts. After manual de-duplication, 25 were removed. Following further screening, 411 articles were excluded. The final analysis included nine eligible full length articles and 2 conference abstracts. The 9 full length articles articles addressed a range of topics: emergency general surgery – ileal perforations (1), endocrine surgery specific to the thyroid gland (1), surgical expenditures (1), surgical availability (1), a surgical experience account in Mauritania (1), youth violence (1), causes of mortality and the burden of trauma (2), and an analysis of terrorist attacks (1). Both conference abstracts were related to emergency general surgery, covering the management of cholecystitis and malignant large bowel obstruction. Conclusion: The literature on surgery and trauma in Mauritania is extremely limited. More epidemiological data, as well as studies on interventions, are necessary to better inform the delivery of global surgical care in this country of approximately 5 million people.