Symptoms and General Pathology

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Cola

Surgical decompression with colostomy with or without resection and eventual re-anastomosis.

Emergency surgery

The colonic stent placement to relieve the colonic obstruction.

Colonic stenting

Zaza Demetrashvili

The study evaluates and compares effect of emergency surgery and colonic stents for treatment of malignant colonic obstructions.

Acute colonic obstruction is one of the common clinical presentations of colorectal cancer. Surgical decompression with colostomy with or without resection and eventual re-anastomosis is the treatment of choice; however, emergency surgery is associated with higher morbidity and mortality.

The colonic stent insertion effectively decompressed the obstructed colon and avoid needs of emergency surgery. This method is a palliation and bridge to surgery. Colonic stents allowed surgery to be performed electively.

Emergency Surgery Versus Colorectal Stents for the Management of Malignant Colonic Obstructions

Emergency Surgery Versus Colorectal Stents for the Management of Malignant Colonic Obstructions: a Prospective Cohort Study

perforation, migration, stent obstruction

Blood loss during emergency surgery or during colonic stenting.

complications which developed in postoperative period

Associate Professor, Surgery Department

Neoplasms

Digestive System Diseases

Rare Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Acute Graft Versus Host Disease

Consecutive adult patients (≥18 years of age) presenting acutely (i.e. unplanned and non-elective presentation to hospital for urgent or emergency reasons) for symptoms of known or unknown colorectal cancer assessed by hospital surgical teams. Patients should be included regardless of operative or non-operative management, and curative or palliative intent.

APOLLO (Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal snapshot) is an international, multi-centre, prospective observational study which will address this need and aims to describe the operative and non-operative management of emergency presentations of colon and rectal cancer in an international cohort.

Primary aim: Describe the variation in the operative and non-operative management of emergency presentations of colon and rectal cancer in an international cohort.

Secondary aims:

* Identify risk factors for mortality (intraoperatively, at 30-days and at 90-days) and ostomy rates (at 30- and 90-days) in patients deemed for active management (i.e., not for palliative management) to develop a risk prediction model
* Validate risk criteria of large bowel obstruction in patients with previously known colorectal cancer undergoing neoadjuvant chemotherapy or awaiting elective surgery

Who?

* Patients aged 18 years and above presenting to the hospital acutely with colorectal cancer (CRC) for malignant large bowel obstruction (LBO), perforation, CRC-related haemorrhage or other reasons within the data collection periods. Both those managed with and without surgery will be included
* Patients with localised and metastatic disease will be included
* Patients with known colorectal cancer diagnoses will be included if they present acutely (e.g., with disease progression)
* Patients presenting acutely for the side effects of chemotherapy/radiotherapy of known cancers will be excluded

What? Data will be collected on patients' presenting status and symptoms, patient management strategies, and intraoperative and postoperative outcomes.

When? Prospectively over 2023 in consecutive 6-week data collection blocks between January and June with 90-day follow-up till September.

Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal Snapshot

Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal Snapshot-An International, Multi-centre Study of Emergency Presentations of Colorectal Cancer

Centre-summaries will be made available to respective centres for audit purposes.

Inpatient mortality, mortality since day of presentation

Rates of stenting in those with left-sided LBO, rates of stenting in those treated with palliative intent, rate of colonic stenting complications

Rate of representation for patients managed nonoperatively

Rates of radiological assessment on admission

Proportion of patients presenting acutely with large bowel obstruction with known colorectal cancer who had high risk criteria for obstruction (as defined by the FOXTroT obstruction criteria) at index assessment

European Student Research Network

Neoplastic Cells, Circulating

patient who received colonic stenting for obstructive colorectal cancer

patients who had only colonoscopy without obstruction and without stenting

Jensen TC Poon, MS

This study aims to examine the hypothesis of tumor cell dissemination after colonic stenting for obstructing colorectal cancer by measuring the level of plasma circulating tumor cell before and after the procedure of successful colonic stenting in patients.

1. Patient recruitment:

   Patients will be recruited from the Division of Colorectal Surgery, Department of Surgery, the University of Hong Kong, over a 12 - 18 months period. Our institution is a tertiary referral center for colorectal cancer patients in Hong Kong. Informed consent will be obtained from the patients after the inclusion criteria are met.

   The study plans to recruit 25 patients in the colonic stenting group to compare with 15 patients in the control group.

   Inclusion criteria:

   Colonic stenting group
   1. Patients with obstructive colorectal cancer that requires colonic stenting as treatment
   2. Age \> 18 years and is able to give informed consent
   3. Informed consent for blood collection obtained

   Control group
   1. Patients with colorectal cancer who have colonoscopy without stenting
   2. Age \> 18 years and is able to give informed consent
   3. Informed consent for blood collection obtained
2. Blood collection and examination for circulating tumor cell

About 10ml of EDTA blood will be collected for examination before the procedure (colonoscopic stenting or colonoscopy in the control group) and blood collection daily will be repeated for 3 days after procedure. Blood will be sent to the laboratory for processing within 2 hours of withdrawal. Circulating tumour cells, which are characterized by CD45- (to exclude hematopoietic cells), CD326+ (to mark epithelial cells), CK18+ and CK19+ (to mark intestinal cells), i.e. cells expressing CD45-CD326+CK18/19+, will be detected by fluorescence activated cell sorting (FACS).

For each ml of blood, 1 ml of FCM Lysing solution will be added and allowed to incubate for 5 minutes to lyse the red blood cells, followed by centrifugation at 1000 RPM for 5 minutes. Supernatant will then be aspirated, and the pellet resuspend in approximately 1 ml cold 1X PBS. 10 µl of the appropriate antibody will be added into the tubes, vortexed and incubated for 15 in dark and room temperature. After incubation, cells will be washed with PBS and then incubated with the second antibody. The process is repeated until all 4 antibodies have been labelled to the cells. Cells will then be analysed on a FACS machine (MoFlo, Beckman Coulter).

Colonic Stent and Tumor Cell Dissemination

Impact of Metallic Stent Insertion for Obstructing Colorectal Cancer on Circulating Tumor Cell Dissemination

The patients' peripheral blood will be collected before and on first 3 days after the procedure.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Emergency Surgery Versus Colorectal Stents for the Management of Malignant Colonic Obstructions	NCT04449822	Colorectal Canc...	Emergency surge... Colonic stentin...	18 Years -	Tbilisi State Medical University
Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal Snapshot	NCT05641129	Colorectal Canc...		18 Years -	European Student Research Network
Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal Snapshot	NCT05641129	Colorectal Canc...		18 Years -	European Student Research Network
Emergency Surgery Versus Colorectal Stents for the Management of Malignant Colonic Obstructions	NCT04449822	Colorectal Canc...	Emergency surge... Colonic stentin...	18 Years -	Tbilisi State Medical University
Emergency Surgery Versus Colorectal Stents for the Management of Malignant Colonic Obstructions	NCT04449822	Colorectal Canc...	Emergency surge... Colonic stentin...	18 Years -	Tbilisi State Medical University
Colonic Stent and Tumor Cell Dissemination	NCT01628328	Colorectal Canc...		18 Years -	The University of Hong Kong
Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal Snapshot	NCT05641129	Colorectal Canc...		18 Years -	European Student Research Network

Spots Global Cancer Trial Database for colonic stenting