Etiological factors and mortality of acute intestinal obstruction: a review of 705 cases.

OBJECTIVE: To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS: Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS: There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION: The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

The effectiveness of intravenous 5-fluorouracil-containing chemotherapy after curative resection for gastric carcinoma: A systematic review of published randomized controlled trials.

This is a review of randomized controlled trials of intravenous 5-flurorouracil (5-FU)-containing chemotherapy after curative resection versus surgery alone in patients with gastric carcinoma to determine the impact on survival rate, safety and economics. Data sources were the Cochrane Library (2006, Issue 2), Pub-Medline and Chinese Biomedical Database. We included 22 randomized controlled trials comparing 4501 patients. Intravenous 5-FU-containing chemotherapy after curative resection had a slightly significant improvement in 3-, 5- and 7-year overall survival rate (OR 1.49, 1.41 and 1.32). No benefit of postoperative disease-free survival rate was induced by 5-FU-containing chemotherapy. Sensitivity analysis was restricted to trials with the highest methodological quality, and the result was similar when the studies with Jadad score less than 3' were excluded. Subgroup analyses found borderline improved overall survival rate in both Western and Eastern countries but the statistical significance was stronger in the Eastern subset. The combinations of 5-FU plus mitomycin C, 5-FU plus cytosine arabinoside and 5-FU plus adriamycin or epidoxorubicin induced potentially more improvement of 3- and 5-year overall survival rates. Severe toxicities were reported in 1629 patients from 15 included trials, and hematological and gastrointestinal toxicities were the most remarkable side effects, around 5%-15% respectively. The chemotherapy-related overall mortality was 1.1%. No trials mentioned cost-effectiveness analysis. Although the results provide some evidence of a beneficial effect of adjuvant chemotherapy with 5-FU-containing regimens, they are inconclusive due to the limitations of methodological quality of including randomized controlled trials. Large scale randomized controlled trials with a positive result are still mandatory before postoperative chemotherapy are recommended.