Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks
In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly con...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1006020/full |
| _version_ | 1828110761904308224 |
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| author | Tianyu Lin Abdul Saad Bissessur Pengfei Liao Tunan Yu Dingwei Chen |
| author_facet | Tianyu Lin Abdul Saad Bissessur Pengfei Liao Tunan Yu Dingwei Chen |
| author_sort | Tianyu Lin |
| collection | DOAJ |
| description | In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy. |
| first_indexed | 2024-04-11T11:23:19Z |
| format | Article |
| id | doaj.art-f957f70991a54496b8881f7ea7edd538 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T11:23:19Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-f957f70991a54496b8881f7ea7edd5382022-12-22T04:26:41ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-09-01910.3389/fsurg.2022.10060201006020Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risksTianyu Lin0Abdul Saad Bissessur1Pengfei Liao2Tunan Yu3Dingwei Chen4Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Surgical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaIn obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.https://www.frontiersin.org/articles/10.3389/fsurg.2022.1006020/fullcolonic obstructioncoronary stentcardiovascular riskself-expandable metallic stentstent-first strategycase report |
| spellingShingle | Tianyu Lin Abdul Saad Bissessur Pengfei Liao Tunan Yu Dingwei Chen Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks Frontiers in Surgery colonic obstruction coronary stent cardiovascular risk self-expandable metallic stent stent-first strategy case report |
| title | Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks |
| title_full | Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks |
| title_fullStr | Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks |
| title_full_unstemmed | Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks |
| title_short | Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks |
| title_sort | case report stent first strategy as a potential approach in the management of malignant right sided colonic obstruction with cardiovascular risks |
| topic | colonic obstruction coronary stent cardiovascular risk self-expandable metallic stent stent-first strategy case report |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1006020/full |
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