Maeda Yoshiaki, Shinohara Toshiki, Minagawa Nozomi, Kobayashi Tadayuki, Koyama Ryota, Shimada Shingo, Tsunetoshi Yusuke, Murayama Keisuke, Hasegawa Haruka
Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan.
Ann Med Surg (Lond). 2020 Jul 23;57:143-147. doi: 10.1016/j.amsu.2020.07.038. eCollection 2020 Sep.
Treatment for acute abdomen during chemotherapy is frequently difficult because of the complicated status of the patients, and there have been only a few case series summarizing the outcomes of emergent surgery during chemotherapy. The aim of this study was to clarify the clinical outcomes of emergency surgery for acute abdomen during chemotherapy and identify predictive factors associated with mortality.
We retrospectively analyzed the records of patients who underwent emergency surgery for acute abdomen within 30-days after anti-cancer drugs administration between 2009 and 2020.
Thirty patients were identified. The primary malignancies were hematological (n = 7), colorectal (n = 4), lung (n = 4), stomach (n = 2), breast (n = 2), prostate (n = 2) and others (n = 5). Fifteen patients were treated with the regimen, including molecular-targeted anti-cancer drugs (Bevacizumab: 8 cases, Rituximab: 4, Ramucirumab: 2, and Gefitinib: 1). Indications for emergency surgery were perforation of the gastrointestinal tract (n = 24), appendicitis (n = 3), bowel obstruction (n = 2), and gallbladder perforation (n = 1). Severe morbidity (Clavien-Dindo IIIa or more) occurred in 8 cases (27%), and there were 6 in-hospital deaths (20%). Significant factors related to in-hospital death were age >70 years old (P = 0.029), poor performance status (ECOG score 1 or 2) (P = 0.0088), and serum albumin level <2.6 g/dl (P = 0.026). The incidence of acute abdomen (odds ratio 5.31, P = 0.00017) was significantly higher in the patients receiving anti-VEGF drugs than in those without anti-VEGF drugs.
This study identified three predictive factors associated with in-hospital death after emergency surgery during chemotherapy: an older age, poor performance status, and low serum albumin level.
由于患者病情复杂，化疗期间急腹症的治疗往往很困难，而且仅有少数病例系列总结了化疗期间急诊手术的结果。本研究的目的是阐明化疗期间急腹症急诊手术的临床结果，并确定与死亡率相关的预测因素。
我们回顾性分析了2009年至2020年间在抗癌药物给药后30天内接受急腹症急诊手术患者的记录。
共确定了30例患者。原发恶性肿瘤为血液系统肿瘤（n = 7）、结直肠癌（n = 4）、肺癌（n = 4）、胃癌（n = 2）、乳腺癌（n = 2）、前列腺癌（n = 2）和其他（n = 5）。15例患者接受了包括分子靶向抗癌药物的治疗方案（贝伐单抗：8例，利妥昔单抗：4例，雷莫西尤单抗：2例，吉非替尼：1例）。急诊手术的指征为胃肠道穿孔（n = 24）、阑尾炎（n = 3）、肠梗阻（n = 2）和胆囊穿孔（n = 1）。8例（27%）发生严重并发症（Clavien-Dindo IIIa级或更高级别），6例住院死亡（20%）。与住院死亡相关的显著因素为年龄>70岁（P = 0.029）、体能状态差（东部肿瘤协作组[ECOG]评分1或2）（P = 0.0088）和血清白蛋白水平<2.6 g/dl（P = 0.026）。接受抗血管内皮生长因子（VEGF）药物治疗的患者急腹症发生率（比值比5.31，P = 0.00017）显著高于未接受抗VEGF药物治疗的患者。
本研究确定了化疗期间急诊手术后与住院死亡相关的三个预测因素：年龄较大、体能状态差和血清白蛋白水平低。
