Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

BACKGROUND: Both gastric bypass (GB) and duodenal switch with sleeve gastrectomy (DS) have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls), and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models

Eating behavior.

<p>Parameters during day- and night-time at 14 weeks after gastric bypass (GB), 8 weeks after duodenal switch (DS) and 8–14 weeks after laparotomy (LAP). Data are expressed as mean ± SEM. *: <i>p</i><0.05, **: <i>p</i><0.01, ***: <i>p</i><0.001 between LAP <i>vs.</i> GB or DS. ^†: <i>p</i><0.05, ^††: <i>p</i><0.01, ^†††: <i>p</i><0.001 between GB <i>vs.</i> DS.</p

Energy expenditure during day- and night-time.

<p>Short-term after surgery: 3 weeks after gastric bypass (GB), 2 weeks after duodenal switch (DS) or 2–3 weeks after laparotomy (LAP). Long-term after surgery: 14 weeks after GB, 8 weeks after DS or 8–14 weeks after LAP. Data are expressed as means ± SEM. *: <i>p</i><0.05, **: <i>p</i><0.01, ***: <i>p</i><0.001, ns: not significant between LAP_GB (n = 7) <i>vs.</i> GB (n = 8) or LAP_DS (n = 6) <i>vs.</i> DS (n = 5).</p

Body weight.

<p>Naïve rats (data from Taconic), rats that underwent laparotomy (LAP) at 13 weeks (LAP) and rats that have had high-fat since 5 weeks of age (data from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0072896#pone.0072896-Furnes3" target="_blank">[31]</a>) (<b>A</b>)<b>.</b> Rats after gastric bypass (GB), duodenal switch (DS) and laparotomy (LAP) (<b>B</b>). Data are expressed as means ± SEM. **: <i>p</i><0.01, ***: <i>p</i><0.001 between LAP <i>vs.</i> GB or DS.</p

Food intake.

<p>Total food intake (kcal/rat) (<b>A,B</b>) and relative food intake (kcal/100 g body weight) (<b>C,D</b>) during day- and night-time. Short-term after surgery: 3 weeks after gastric bypass (GB), 2 weeks after duodenal switch (DS) or 2–3 weeks after lapatoromy (LAP). Long-term after surgery: 14 weeks after GB, 8 weeks after DS or 8–14 weeks after LAP. Data are expressed as means ± SEM. *: <i>p</i><0.05, **: <i>p</i><0.01, ns: not significant between LAP (n = 13) <i>vs.</i> GB (n = 8) or DS (n = 5).</p