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Colorectal Cancer Surgical Emergency in Transplanted Patients

  • Lelde Lauka
  • Giulio Vitali
  • Thierry Berney
  • Nicola de’Angelis
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide with 1.4 million new cancer cases in 2012; it is the third most common cancer in men and second in women (Ferlay et al., Int J Cancer 136(5):E359–E386, 2015). The risk for developing CRC in patients after solid organ transplantation (SOT) is increased in comparison with general population. With growing numbers of transplantation worldwide, it is likely that a general surgeon will encounter a patient with graft-unrelated surgical problem, especially in emergency setting. Significant part of colorectal cancer patients has emergency presentation during the course of the disease; the acute condition can be an initial event that leads to the diagnosis of CRC, and it can also occur in later stages. When managing patients after SOT, several particularities must be considered as these patients have chronically decreased immune defense due to lifelong immunosuppressive therapy. In this population, the course of surgical emergency is associated with higher morbidity and mortality rates; therefore the decision of surgical treatment should not be delayed. However, oncological principles should be followed whenever feasible.

Keywords

Colorectal cancer Solid organ transplantation Chronic immunosuppression Colorectal emergency Perioperative management 

References

  1. 1.
    Carmona M, Alvarez M, Marco J, Mahíllo B. Organ donation and transplantation activities 2015 report. Global Observatory on Donation and Transplantation. September 2017. Available at: http://www.transplant-observatory.org.
  2. 2.
    Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/ AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59–67.CrossRefGoogle Scholar
  3. 3.
    Engels EA, Pfeiffer RM, Fraumeni JF Jr, Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011;306(17):1891–901.CrossRefGoogle Scholar
  4. 4.
    Chapman JR, Webster AC, Wong G. Cancer in the transplant recipient. Cold Spring Harb Perspect Med. 2013;3(7):a015677.CrossRefGoogle Scholar
  5. 5.
    Safaeian M, Robbins HA, Berndt SI, Lynch CF, Fraumeni JF Jr, Engels EA. Risk of colorectal cancer after solid organ transplantation in the United States. Am J Transplant. 2016;16:960–7.CrossRefGoogle Scholar
  6. 6.
    Collett D, Mumford L, Banner NR, Neuberger J, Watson C. Comparison of the incidence of malignancy in recipients of different types of organ: a UK Registry audit. Am J Transplant. 2010;10:1889–96.CrossRefGoogle Scholar
  7. 7.
    Tsaitas C, Semertzidou A, Sinakos E. Update on inflammatory bowel disease in patients with primary sclerosing cholangitis. World J Hepatol. 2014;6(4):178–87.CrossRefGoogle Scholar
  8. 8.
    Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MO. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc. 2002;56:48–54.CrossRefGoogle Scholar
  9. 9.
    Hadjiliadis D, Khoruts A, Zauber AG, Hempstead SE, Maisonneuve P, Lowenfels AB. Cystic fibrosis colorectal cancer screening consensus recommendations. Gastroenterology. 2018;154(3):736–45.CrossRefGoogle Scholar
  10. 10.
    Papaconstantinou HT, Sklow B, Hanaway MJ, et al. Characteristics and survival patterns of solid organ transplant patients developing de novo colon and rectal cancer. Dis Colon Rectum. 2004;47:1898–903.CrossRefGoogle Scholar
  11. 11.
    Fishman JA, Issa NC. Infection in organ transplantation: risk factors and evolving patterns of infection. Infect Dis Clin N Am. 2010;24(2):273–83.CrossRefGoogle Scholar
  12. 12.
    Gohh RY, Warren G. The preoperative evaluation of the transplanted patient for nontransplant surgery. Surg Clin North Am. 2006;86(5):1147–66.CrossRefGoogle Scholar
  13. 13.
    Fishman JA, the AST Infectious Diseases Community of Practice. Introduction: infection in solid organ transplant recipients. Am J Transplant. 2009;9(Suppl 4):S3–6.CrossRefGoogle Scholar
  14. 14.
    European Centre for Disease Prevention and Control. Systematic review and evidence-based guidance on perioperative antibiotic prophylaxis. Stockholm: ECDC; 2013.Google Scholar
  15. 15.
    Bratzler DW, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283.CrossRefGoogle Scholar
  16. 16.
    Girlanda R. Complications of post-transplant immunosuppression, Chapter 33. In:Regenerative medicine and tissue engeneering. Croatia: Intech; 2013.Google Scholar
  17. 17.
    Angeli F, Verdecchia P, Karthikeyan G, Mazzotta G, Gentile G, Reboldi G. β-Blockers reduce mortality in patients undergoing high-risk non-cardiac surgery. Am J Cardiovasc Drugs. 2010;10(4):247–59.CrossRefGoogle Scholar
  18. 18.
    Ojo AO, Held PJ, Port FK. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349:931–8.CrossRefGoogle Scholar
  19. 19.
    Kelly KN, Domajnko B. Perioperative stress-dose steroids. Clin Colon Rectal Surg. 2013;26(3):163–7.CrossRefGoogle Scholar
  20. 20.
    Burke GW, Ciancio G, Cirocco R, Markou M, Coker D, Roth D, Nery J, Esquenazi V, Miller J. Association of interleukin-10 with rejection-sparing effect in septic kidney transplant recipients. Transplantation. 1996;61(7):1114–6.CrossRefGoogle Scholar
  21. 21.
    Chou NK, et al. Sparing immunosuppression in heart transplant recipients with severe sepsis. Transplant Proc. 2006;38(7):2145–6.CrossRefGoogle Scholar
  22. 22.
    Abel GA, Shelton J, Johnson S, et al. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. Br J Cancer. 2015;112(Suppl 1):S129–36.CrossRefGoogle Scholar
  23. 23.
    Gunnarsson H, Holm T, Ekholm A, Olsson LI. Emergency presentation of colon cancer is most frequent during summer. Colorectal Dis. 2011;13(6):663–8.CrossRefGoogle Scholar
  24. 24.
    Kim J, Mittal R, Konyalian V, King J, Stamos MJ, Kumar RR. Outcome analysis of patients undergoing colorectal resection for emergent and elective indications. Am Surg. 2007;73(10):991–3.PubMedGoogle Scholar
  25. 25.
    Bass G, Flemin C, Conneely J, Martin Z, Mealy K. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: review of 356 consecutive Irish patients. Dis Colon Rectum. 2009;52(4):678–84.CrossRefGoogle Scholar
  26. 26.
    Teixeira F, et al. Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J Emerg Surg. 2015;10:5.CrossRefGoogle Scholar
  27. 27.
    Weixler B, et al. Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer. 2016;16:208.CrossRefGoogle Scholar
  28. 28.
    De’Angelis N, et al. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg. 2016;11(1):43.CrossRefGoogle Scholar
  29. 29.
    De’Angelis N, Brunetti F, Azoulay D. Common surgical emergencies in transplanted patients. In: Di Saverio S, Catena F, Ansaloni L, Coccolini F, Velmahos G, editors. Acute care surgery handbook. Cham: Springer; 2017.Google Scholar
  30. 30.
    Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surg Clin N Am. 2017;97:529–45.CrossRefGoogle Scholar
  31. 31.
    Barnett A, Cedar A, Siddiqui F, Herzig D, Fowlkes E, Thomas CR Jr. Colorectal cancer emergencies. J Gastrointest Cancer. 2013 Jun;44(4):132–42.CrossRefGoogle Scholar
  32. 32.
    Chang GJ, Kaiser AM, Mills S, Rafferty F, Buie WD. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55:831–43.CrossRefGoogle Scholar
  33. 33.
    Liu HY, Liang XB, Li YP, Feng Y, Liu DB, Wang WD. Treatment of advanced rectal cancer after renal transplantation. World J Gastroenterol. 2011;17(15):2058–60.CrossRefGoogle Scholar
  34. 34.
    Zittel TT, Mehl CFR, Reichmann U, Becker HD, Jehle EC. Treatment of advanced rectal cancer in a patient after combined pancreas–kidney transplantation. Langenbecks Arch Surg. 2004;389(1):6–10.CrossRefGoogle Scholar
  35. 35.
    Fang W. Chemotherapy in patient with colon cancer after renal transplantation: a case report with literature review. Medicine (Baltimore). 2018;97(5):e9678.CrossRefGoogle Scholar
  36. 36.
    Frago R, Ramirez E, Millan M, Kreisler E, del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207(1):127–38.CrossRefGoogle Scholar
  37. 37.
    Ansaloni L, et al. Guidelines in the management of obstructing cancer of the left colon: consensus conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society. World J Emerg Surg. 2010;5:29.CrossRefGoogle Scholar
  38. 38.
    Yeo ES. Perforated colorectal cancer: an important differential diagnosis in all presumed diverticular abscesses. Ann Acad Med Singap. 2011;40(8):375–8.PubMedGoogle Scholar
  39. 39.
    Abu-Hejleh T, Mezhir JJ, Goodheart MJ, Halfdanarson TR. Incidence and management of gastrointestinal perforation from bevacizumab in advanced cancers. Curr Oncol Rep. 2012;14(4):277–84.CrossRefGoogle Scholar
  40. 40.
    Tavakkolizadeh A, Ashley S. Acute gastrointestinal hemorrhage. Sabiston textbook of surgery: the biological basis of modern surgical practice. Philadelphia: Elsevier; 2012.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lelde Lauka
    • 1
    • 2
  • Giulio Vitali
    • 3
  • Thierry Berney
    • 3
  • Nicola de’Angelis
    • 1
    • 2
  1. 1.Service of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Unit of Minimally Invasive and Robotic SurgeryHenri Mondor Hospital, AP-HPCréteilFrance
  2. 2.University of Paris Est, UPECCréteilFrance
  3. 3.Service of Abdominal Surgery and Liver TransplantationGeneva University Hospital and Medical SchoolGenevaSwitzerland

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