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RÉSUMÉ
Objectif. Décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutives des occlusions sur carcinose péritonéale dans 3 hôpitaux de référence de Douala et Yaoundé. Méthodologie. Nous avons mené une étude descriptive rétrospective du 1er janvier 2017 au 31 Décembre 2021 (5 ans) à partir des dossiers cliniques des patients diagnostiqués d’une occlusion sur carcinose péritonéale dans les services d’oncologie et de chirurgie viscérale de 3 hôpitaux de référence des villes de Douala et Yaoundé. Les variables étudiées étaient les données sociodémographiques, cliniques et paracliniques, thérapeutiques et évolutives. Résultats. Sur 12 553 dossiers dépouillés, 243 (1,93%) cas d’occlusions intestinales ont été répertoriés et parmi eux 37 (15,22%) étaient des occlusions sur carcinose péritonéale, dont 6 ont été exclus pour informations incomplètes. L’âge moyen était de 54,22 (±18) ans, avec une prédominance féminine (18 ; 58,06%). Les cancers primitifs les plus retrouvés étaient le cancer colorectal (45,15%) et le cancer de l’ovaire (19,35%). Les manifestations cliniques les plus retrouvées étaient la douleur abdominale (100%) et l’arrêt des matières et des gaz (90,32%). L’occlusion était basse dans 70,96% des cas. Le traitement médical était l’option thérapeutique la plus utilisée dans 64,52% des cas. La médiane de survie était de 3,26 mois. Il n’y avait pas d’association significative entre la survie et le type de traitement utilisé. Conclusion. Les occlusions sur carcinose péritonéale représentent 15% des occlusions intestinales dans notre contexte. La survie globale n’est pas associée au type de traitement.
ABSTRACT
Objective. To report the epidemiological, clinical, therapeutic and evolutionary characteristics of bowel obstructions due to peritoneal carcinomatosis in 3 referral hospitals in Douala and Yaoundé. Methodology. We conducted a retrospective analytical study from January 1er 2017 to December 31 2021 (5 years) based on the clinical records of patients diagnosed with Bowel obstructions due to peritoneal carcinomatosis in the oncology and visceral surgery departments of 3 referral hospitals in the cities of Douala and Yaoundé. The variables studied were socio-demographic, clinical and paraclinical, therapeutic and evolutionary data. Results. 243 (1.93%) cases of Bowel obstruction were identified out of 12,553 records. Of these, 37 (15.22%) were obstructions due to peritoneal carcinosis, 6 of which were excluded for incomplete information. The mean age was 54.22 (±18) years, with a female predominance (18; 58.06%). The most common primary cancers were colorectal (45.15%) and ovarian (19.35%). The most common clinical manifestations were abdominal pain (100%) and cessation of bowel movements and gas (90.32%). Occlusion was low in 70.96% of cases. Medical treatment was the most commonly used therapeutic option in 64.52% of cases. Median survival was 3.26 months. There was no significant association between survival and the type of treatment used. Conclusion. Occlusions due to peritoneal carcinosis account for 15% of intestinal occlusions in our setting. Overall survival is not associated with the type of treatment.
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References
- Denis B, Elias D. prise en charge symptomatique de la carcinose péritonéale. Gastroenterol Clin Biol. 28e éd. 2004;17.
- Benlahfid M, Erguibi D, Elhattabi K, Bensardi F, Khaiz D, Lafriekh R, et al. Epidémiologie descriptive de la carcinose péritonéale d’origine digestive l’hôpital universitaire Ibn Rochd de Casablanca (2008-2010). Panafrican Med Journal. 2017;
- Laval G, Marcelin-Beazeh B, Arvieux C, Chauvenet L, Copel L, Durand A, et al. Traitement symptomatique de l’occlusion intestinale sur carcinose péritonéale : recommandations de bonnes pratiques cliniques. Médecine palliative- soins de support- Accompagnement-Ethique. 11e éd. 2012; 5‑24.
- Ripamonti C, Mercadante S, Doyle D, Hanks G, Mc Donald N, Cherny N. Pathophysiology and management of malignant bowel obstruction. 3e éd. New York: Oxford University Press; 2005. (Eds Oxford Textbook of palliative medicine).
- Samuel P Banting, Peadar S Waters , Oliver Peacock , Vignesh Narasimhan , Andrew C Lynch , Jacob J McCormick , Satish K Warrier , Alexander G Heriot. Management of primary and metastatic malignant small bowel obstruction, operate or palliate. A systematic review. ANZ J. Surg. 91e éd. 2021;282‑90.
- Calabrese D, Bifulco L, Kianmanesh R, Msika S. Traitement des pathologies tumorales du péritoine.; EMC Gastro; vol. 13 ; Elsevier Masson; 2018.
- Esquivel J, Chua T, Stojadinovic A, Melero J, Levine E, Gutman M, et al. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J of Surg Oncol. 2010;565‑70.
- Santangelo ML, Grifasi C, Criscitiello C, Giuliano M, Calogero A, Dodaro C, et al. Bowel obstruction and peritoneal carcinomatosis in the elderly. Q systematic review. Aging Clin Exp Res. 2016;
- Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F. Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J of pain and symptom management. 2011;412‑20
- Shariat-Madar B, Jayakrishman T, Clark Gamblin T, Turaga KK. Surgical management of bowel obstruction in patient with peritoneal carcinomatosis. J of Surg Oncol. 2014;
- Pothuri B, Meyer L, Gerardi M, Barakat RR, Chi DS. Reoperation for palliation of recurrent malignant bowel obstruction in ovarian carcinoma. Gyn Oncol. 2004;193‑5.
- Helyer LK, Law CH, Butler M, Last LD, Smith AJ, Wright FC. Surgery as a bridge to palliative chemotherapy in patients with malignant bowel obstruction from colorectal cancer.; Ann of Surg Oncol; vol. 14.; 2007. 1264‑1271
- Blair SL, Chu DZ, Schwarz RE. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. . Ann of Surg Oncol; vol. 8; 2001. 632‑637
- Olson PTJ, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis. JAMA Surg. 2014;149(4):383‑92.
- Castro PM, Vargas L, Mancheño A, Utrilla SM, Pascual F, Romero I, et al. Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis. Int J Gynecol Cancer. 2017
- J.D. Brierley et al. TNM classification of malignant tumours. 8th edition: UICC. Ed. Wiley Blackwell;2017.
- Picot J, Cooper K, Bryant J, Clegg AJ. Karnofsky performance status and WHO performance status scores. NIHR journal Library [Internet]. United Kingdom; 2011 [cited 2017 Jun 11]; Available from:https://www.ncbi.nlm.nih.gov/books/NBK97482/
- De Boer NL, Hagemans JAW, Schultze BTA, Brandt-Kerkhof AR., Madsen EVE, Verhoef C, et al. Acute malignant obstruction in patients with peritoneal carcinomatosis: the role of palliative surgery. Eur J Surg Oncol 2018.
- Romeo M, De los Llanos Gil M, Cuadra Urteaga JL, Vilà L, Ahlal S, Indacochea A, et al. Outcome pronostic factors in inoperable malignant bowel obstruction. Support care cancer. 2016;
- Dalal KM, Gollub MJ, Miner TJ, Wong WD, Gerdes H, Schattner MA, et al. Management of patients with malignant bowel obstruction and stage IV colorectal cancer. Journal of Palliative Medecine. 14e éd. 2011;822‑8.
- Arvieux C, Laval G, Mestrallet J, Stefani L, Villard M, Cardin N. Treatment of malignant intestinal obstruction. A prospective study over 80 cases. Ann Chi. 2005;470‑6.
- Romeo M, De los Llanos Gil M, Cuadra Urteaga JL, Vilà L, Ahlal S, Indacochea A, et al. Outcome pronostic factors in inoperable malignant bowel obstruction. Support care cancer. 2016.
- Laval G, Marcellin-Benazech B, Guirimand F, Chauvenet L, Copel L, Durand A, et al. Recommandations for bowel obstruction with peritoneal carcinomatosis. J of pain and symptom management. 2014;
- Toussaint S, Aufffret K, Brocard F, Cervi C, Dubuc M, Hutin-Brissot A, et al. Occlusion digestive sur carcinose péritonéale. Référentiels inter régionaux en soins oncologiques de support; 2013.
- Amikura K, Sakamoto H, Yatsuoka T, Kawashima Y, Nishimura Y, Tanaka Y. Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma. J Surg Oncol. 101e éd. 2010;228‑32.
- Higashi H, Shida H, Ban K, Yamagata S, Masuda K, Imanari T, et al. Factors affecting successful palliative surgery for malignant obstruction due to peritoneal dissemination from colorectal cancer. Jpn J Clin Oncol. 2003;357‑9.
References
Denis B, Elias D. prise en charge symptomatique de la carcinose péritonéale. Gastroenterol Clin Biol. 28e éd. 2004;17.
Benlahfid M, Erguibi D, Elhattabi K, Bensardi F, Khaiz D, Lafriekh R, et al. Epidémiologie descriptive de la carcinose péritonéale d’origine digestive l’hôpital universitaire Ibn Rochd de Casablanca (2008-2010). Panafrican Med Journal. 2017;
Laval G, Marcelin-Beazeh B, Arvieux C, Chauvenet L, Copel L, Durand A, et al. Traitement symptomatique de l’occlusion intestinale sur carcinose péritonéale : recommandations de bonnes pratiques cliniques. Médecine palliative- soins de support- Accompagnement-Ethique. 11e éd. 2012; 5‑24.
Ripamonti C, Mercadante S, Doyle D, Hanks G, Mc Donald N, Cherny N. Pathophysiology and management of malignant bowel obstruction. 3e éd. New York: Oxford University Press; 2005. (Eds Oxford Textbook of palliative medicine).
Samuel P Banting, Peadar S Waters , Oliver Peacock , Vignesh Narasimhan , Andrew C Lynch , Jacob J McCormick , Satish K Warrier , Alexander G Heriot. Management of primary and metastatic malignant small bowel obstruction, operate or palliate. A systematic review. ANZ J. Surg. 91e éd. 2021;282‑90.
Calabrese D, Bifulco L, Kianmanesh R, Msika S. Traitement des pathologies tumorales du péritoine.; EMC Gastro; vol. 13 ; Elsevier Masson; 2018.
Esquivel J, Chua T, Stojadinovic A, Melero J, Levine E, Gutman M, et al. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J of Surg Oncol. 2010;565‑70.
Santangelo ML, Grifasi C, Criscitiello C, Giuliano M, Calogero A, Dodaro C, et al. Bowel obstruction and peritoneal carcinomatosis in the elderly. Q systematic review. Aging Clin Exp Res. 2016;
Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F. Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J of pain and symptom management. 2011;412‑20
Shariat-Madar B, Jayakrishman T, Clark Gamblin T, Turaga KK. Surgical management of bowel obstruction in patient with peritoneal carcinomatosis. J of Surg Oncol. 2014;
Pothuri B, Meyer L, Gerardi M, Barakat RR, Chi DS. Reoperation for palliation of recurrent malignant bowel obstruction in ovarian carcinoma. Gyn Oncol. 2004;193‑5.
Helyer LK, Law CH, Butler M, Last LD, Smith AJ, Wright FC. Surgery as a bridge to palliative chemotherapy in patients with malignant bowel obstruction from colorectal cancer.; Ann of Surg Oncol; vol. 14.; 2007. 1264‑1271
Blair SL, Chu DZ, Schwarz RE. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. . Ann of Surg Oncol; vol. 8; 2001. 632‑637
Olson PTJ, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis. JAMA Surg. 2014;149(4):383‑92.
Castro PM, Vargas L, Mancheño A, Utrilla SM, Pascual F, Romero I, et al. Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis. Int J Gynecol Cancer. 2017
J.D. Brierley et al. TNM classification of malignant tumours. 8th edition: UICC. Ed. Wiley Blackwell;2017.
Picot J, Cooper K, Bryant J, Clegg AJ. Karnofsky performance status and WHO performance status scores. NIHR journal Library [Internet]. United Kingdom; 2011 [cited 2017 Jun 11]; Available from:https://www.ncbi.nlm.nih.gov/books/NBK97482/
De Boer NL, Hagemans JAW, Schultze BTA, Brandt-Kerkhof AR., Madsen EVE, Verhoef C, et al. Acute malignant obstruction in patients with peritoneal carcinomatosis: the role of palliative surgery. Eur J Surg Oncol 2018.
Romeo M, De los Llanos Gil M, Cuadra Urteaga JL, Vilà L, Ahlal S, Indacochea A, et al. Outcome pronostic factors in inoperable malignant bowel obstruction. Support care cancer. 2016;
Dalal KM, Gollub MJ, Miner TJ, Wong WD, Gerdes H, Schattner MA, et al. Management of patients with malignant bowel obstruction and stage IV colorectal cancer. Journal of Palliative Medecine. 14e éd. 2011;822‑8.
Arvieux C, Laval G, Mestrallet J, Stefani L, Villard M, Cardin N. Treatment of malignant intestinal obstruction. A prospective study over 80 cases. Ann Chi. 2005;470‑6.
Romeo M, De los Llanos Gil M, Cuadra Urteaga JL, Vilà L, Ahlal S, Indacochea A, et al. Outcome pronostic factors in inoperable malignant bowel obstruction. Support care cancer. 2016.
Laval G, Marcellin-Benazech B, Guirimand F, Chauvenet L, Copel L, Durand A, et al. Recommandations for bowel obstruction with peritoneal carcinomatosis. J of pain and symptom management. 2014;
Toussaint S, Aufffret K, Brocard F, Cervi C, Dubuc M, Hutin-Brissot A, et al. Occlusion digestive sur carcinose péritonéale. Référentiels inter régionaux en soins oncologiques de support; 2013.
Amikura K, Sakamoto H, Yatsuoka T, Kawashima Y, Nishimura Y, Tanaka Y. Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma. J Surg Oncol. 101e éd. 2010;228‑32.
Higashi H, Shida H, Ban K, Yamagata S, Masuda K, Imanari T, et al. Factors affecting successful palliative surgery for malignant obstruction due to peritoneal dissemination from colorectal cancer. Jpn J Clin Oncol. 2003;357‑9.