ABSTRACT
The key priority for obstructed colon cancer (OCC) is urgent resolution of the large bowel obstruction with ideally no compromise of oncological outcomes and low initial and permanent ostomy rates. Proactive management is pivotal to decrease the risk of perforation and septic shock. Staged procedures have an important place to provide optimal treatment and offer similar treatment and outcomes as in the elective setting. The approach is tailored to the patient's condition, the oncological situation and expertise of the available surgical team. This overview concludes by proposing a comprehensive treatment algorithm for individualized treatment of OCC.
La principale priorité du cancer du côlon obstructif (CCO) est la levée urgente de l'obstacle colique, sans compromettre les résultats oncologiques tout en réduisant les taux de stomies initiales et permanentes. Une prise en charge proactive est essentielle pour minimiser le risque de perforation et de choc septique. Les procédures par étapes (staged procedures) ont une place primordiale afin de permettre un traitement optimal associé à des résultats proches des conditions de la chirurgie élective. L'approche doit être adaptée à l'état des patients, au stade oncologique, ainsi qu'à l'expertise chirurgicale disponible. Cette synthèse de la littérature se conclut par la proposition d'un algorithme pour le traitement individualisé du CCO.
Subject(s)
Colonic Neoplasms , Intestinal Obstruction , Colon , Colonic Neoplasms/complications , Colonic Neoplasms/therapy , Elective Surgical Procedures , Humans , Intestinal Obstruction/surgeryABSTRACT
OBJECTIVES: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising treatment for peritoneal cancer that entails, however, potential risks for the caregivers in the operating room (OR). This study aimed to reach a consensus within the PIPAC community on a comprehensive safety protocol. METHODS: Active PIPAC centers were invited to participate in a two-round Delphi process on 43 predefined items: concise summaries of the existing evidence were presented together with questions formulated using the population, intervention, comparator, and outcome framework. According to the Grading of Recommendations Assessment, Development, and Evaluation, the strength of recommendation was voted by panelists, accepting a consensus threshold of ≥50% of the agreement for any of the four grading options, or ≥70% in either direction. RESULTS: Forty-seven out of 66 invited panelists answered both rounds (response rate 76%). The consensus was reached for 41 out of 43 items (95.3%). Strong and weak recommendations were issued for 30 and 10 items, respectively. A positive consensual recommendation was issued to activate laminar airflow without specific strength, neither strong nor weak. No consensus was reached for systematic glove change for caregivers with a high risk of exposure and filtering facepiece mask class 3 for caregivers with low risk of exposure. CONCLUSIONS: A high degree of consensus was reached for a comprehensive safety protocol for PIPAC, adapted to the risk of exposure for the different caregivers in the OR. This consensus can serve as a basis for education and help reach a high degree of adherence in daily practice.