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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

Digestive System Diseases

Postoperative Complications

Diverticulitis

Intestinal Perforation

Diverticulum

Diverticular Diseases

Gastroenteritis

Gastrointestinal Diseases

Primary anastomosis refers to a colonic resection with primary anastomosis and covering ileostomy, followed by a stoma reversal operation.

Hartmann's operation is the surgical resection of the rectosigmoid colon with closure of the rectal stump and end colostomy, followed by a stoma reversal operation.

Hartmann's operation

Primary anastomosis refers to a colonic resection with primary anastomosis and covering proximal ileostomy, followed by a stoma reversal operation.

Primary anastomosis

Stefan Breitenstein, MD

The purpose of this multi-center randomized trial is to identify any differences in the complication rates of patients undergoing Hartmann's (end colostomy) versus Primary Anastomosis (with defunctioning ileostomy) for left-sided colonic performation (including the stoma reversal operation).

Hartmann's operation: the surgical resection of the rectosigmoid colon with closure of the rectal stump and end colostomy.

End colostomy: A stoma is created from one end of the bowel while the other portion of the bowel is either removed or sewn shut (Hartmann's pouch).

The second operation (reversal) requires a colo-rectal anastomosis.

Primary anastomosis: colonic resection with primary anastomosis and defunctioning ileostomy. The second operation (stoma reversal) requires an entero-enteral anastomosis.

Anastomosis: is to join together two bowel ends to restore continuity after resection or stoma formation.

Colostomy: is a reversible surgical procedure in which a stoma is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel for feces to leave the body.

Ileostomy is a surgical opening constructed by bringing the loop of small intestine (the ileum) out onto the surface of the skin.

Hartmann's Versus Primary Anastomosis in Left-sided Colon Perforation

Hartmann's Versus Primary Anastomosis in Left-sided Colon Perforation - A Prospective Randomized Multicenter Trial

The Clavien-Dindo Classification of Surgical Complications:

Grade I: Any deviation from the normal postoperative course without the need for treatment. Grade II: Requiring pharmacological treatment with drugs. Grade III: Requiring surgical, endoscopic or radiological intervention. Grade IV: Life-threatening complication requiring IC/ICU-management. Grade V: Death of a patient

Primary operation: the one the patients were randomized to, either Hartmann's or Primary anastomosis

Reversal operation is the one of either the colostomy (Hartmann's) or the ileostomy (Primary anastomosis)

Sum of the number of different complications

Primary operation is the one patients were randomized into.

Reversal rate is the proportion of patients having their stoma reversed (second operation)

Duration of the primary procedure, the reversal procedure, and overall (minutes)

Cost of the primary operation, the reversal, and combined, in US dollars.

Kantonsspital Winterthur KSW

University of Lausanne

Kantonsspital Graubünden

University of Zurich

Neoplasms

Rare Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

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

Laparoscopic operation

Open operation

Marie Grönroos-Korhonen, MD

Jyrki Kössi, adj Prof

Marie Grönroos-Korhonen

Jyrki Kössi, Doc

Marie T Grönroos-Korhonen, MD

This is a randomized, controlled, parallel, multicenter trial to compare post-operative complications and long-term results between open and laparoscopic technique in emergency colorectal surgery.

Laparoscopic technique in elective colorectal surgery has been shown to be advantageous for patients compared to open technique. However, the feasibility and potential benefits of laparoscopic colorectal surgery in emergency setting has not been evaluated sufficiently.

The aim of this study is to compare laparoscopic and open technique in emergency colon resections. Primary outcome is the immediate recovery after operation and secondary outcome is long-term overall and cancer-specific survival.

This is a prospective randomized controlled multicenter trial

Laparoscopic Approach for Emergency Colon Resection

Laparoscopic Approach for Emergency Colon Resection: a Randomized Controlled Trial

Postoperative morbidity evaluated by Clavien-Dindo classification

Surgical site infections, superficial and deep

Long-term overall and cancer-specific survival

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
Hartmann's Versus Primary Anastomosis in Left-sided Colon Perforation	NCT01233713	Surgery Diverticulitis Neoplasms Postoperative C...	Hartmann's oper... Primary anastom...	18 Years - 95 Years	University of Zurich
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
Laparoscopic Approach for Emergency Colon Resection	NCT05005117	Laparoscopic Su... Colorectal Canc... Colorectal Diso... Emergencies Complication of... Long-term Effec...	Laparoscopic op... Open operation	18 Years - 100 Years	Joint Authority for Päijät-Häme Social and Health Care
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

Spots Global Cancer Trial Database for emergency surgery