RESUMO
The purpose of this multi-institutional retrospective study was to expand the available data pertaining to pre-operative clinical findings, progression-free and overall survival times, and potential prognostic factors for cats undergoing surgery for intestinal adenocarcinomas. Fifty-eight cats treated over a 12-year period were included in the study. Progression-free and overall survival times were estimated using Kaplan-Meier analyses. Potential prognostic variables were evaluated for associations with progression-free and overall survival using univariate Cox proportional hazards regression analyses. Prior to surgery, the intestinal mass was identified using ultrasonography in 89% of cats in which it was applied; however, imaging findings suggestive of intrathoracic metastases were observed in only 9% of cats. Among 22 cats undergoing ultrasound-guided fine needle aspiration cytology, the results agreed with the results of histopathology in only 10 cats. Discordant results were most commonly related to the presence of marked inflammation in cytology samples, which may have obscured the presence of neoplastic cells. Diffuse intestinal small cell lymphoma was identified as a comorbidity in 5 cats. Resection of the tumor with the objective of obtaining wide surgical margins was performed in each cat. On histopathology, 20 tumors were classified as mucinous adenocarcinoma and 28 were adenocarcinoma not otherwise specified. Intestinal transection site margins were complete in 94% of cats; however, complete mural margins were present in only 15% of cats. Local lymph node metastases were identified in 52% of cats and carcinomatosis was diagnosed in 81% of cats. Disease progression was documented in 32 of the 58 cats (55%). Of these 32 cats, 14 (43%) had local recurrence of the primary intestinal tumor. Median progression-free survival was 203 days (95% CI 130-299 days), and median overall survival time was 284 days (95% CI 200-363 days). Mitotic count was inversely associated with progression-free survival (HR 1.04; 95% CI 1.01-1.07, P = 0.005); however, none of the remaining potential prognostic factors, including administration of adjuvant chemotherapy, were significantly associated with progression-free or overall survival. Feline intestinal adenocarcinoma remains an aggressive and highly fatal disease. Large, randomized controlled clinical trials will be needed to improve the survival prospects for affected cats.
RESUMO
OBJECTIVE: To describe 4 Great Danes with colonic torsions and describe the risk of torsion recurrence in this breed, which has not previously been reported. This study also describes pneumocolon as a rapid and noninvasive diagnostic for confirmation of colonic torsion. SERIES SUMMARY: Four Great Danes were presented with nonspecific gastrointestinal (GI) clinical signs. Colonic torsion was diagnosed in each case with either plain radiography identifying pneumocolon or contrast radiography (barium enema). Bloodwork in each case revealed nonspecific changes. Each case had a previous gastropexy, 3 of which were prophylactic and 1 as a surgical emergency for gastric dilatation-volvulus. Three cases had favorable outcomes with emergency surgical intervention and returned to normal activity levels with resolution of clinical signs. Two cases of colonic torsion recurred, 1 of which occurred subsequent to a prior left-sided colopexy. One case of recurrence had persistent clinical signs following surgical revision and was euthanized. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report describing pneumocolon to identify a colonic torsion, providing a rapid and low-morbidity diagnostic aid and to describe the recurrence of colonic torsion in 2 dogs. Support to a previous hypothesis for an association between colonic torsion and altered GI motility is provided. Prior publications reporting colonic torsion and entrapment in German Shepherd Dogs associated with disruption of the duodenocolic ligament reported no recurrence following correction without colopexy. The recurrence in these 2 dogs suggests colonic torsion in Great Danes may represent a different or more severe form of this condition.
