scholarly journals Impact of anaemia at discharge following colorectal cancer surgery

2020 ◽  
Vol 35 (9) ◽  
pp. 1769-1776
Author(s):  
Rebecca C. Dru ◽  
Nathan J. Curtis ◽  
Emma L. Court ◽  
Catherine Spencer ◽  
Sara El Falaha ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cancer Surgery ◽  
Curative Intent ◽  
Colorectal Cancer Surgery ◽  
Colorectal Cancer Resection ◽  
Long Term Impact ◽  
L 14

Abstract Objectives Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. Methods A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. Results A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0–200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5–11] vs. 6 [5–8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04–2.5), p = 0.034). Conclusion Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.

scholarly journals Association Between Enrollment in an Enhanced Recovery Program for Colorectal Cancer Surgery and Long-Term Recurrence and Survival

2021 ◽  
Author(s):  
Andrés Zorrilla Vaca ◽  
Javier Ripolles-Melchor ◽  
Ane Abad-Motos ◽  
Inés Rubiera Mingu ◽  
Nekane Moreno-Jurado ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Subgroup Analysis ◽  
Enhanced Recovery ◽  
Compliance Rate ◽  
Cancer Surgery ◽  
Cancer Stage ◽  
Colorectal Cancer Surgery

Abstract IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to minimize the surgical inflammatory response in colorectal cancer, leading to early patient recovery and better postoperative outcomes. Our objective was to determine the association between an ERAS program for colorectal cancer surgery and oncologic recurrence and survival.MethodsA before-after intervention study was designed including patients who underwent colorectal cancer surgery between November 2010 and March 2016. During the study period the institutional criteria for adjuvant therapy remained unchanged and all patients were followed up for 5 years. Cox hazard regression analysis was performed per cumulative year of follow up to evaluate the association between ERAS program exposure and overall survival, cancer-related mortality, and oncologic recurrence. Subgroup analysis was performed by cancer stage (low [I/II] vs advanced [III/IV]).ResultsIn total, 612 patients were included, of which 321 were pre-ERAS and 291 ERAS. Our overall median compliance rate with ERAS interventions was 90% (IQR 85%-95%). Overall survival rates were higher in the ERAS group within the first 2-years after surgery (89.2% vs 83.2%, P=0.04), but there was no difference at 5-year follow up (73.3% vs 72.5%, P=0.82). Subgroup analysis revealed the ERAS enrollment was associated with a significantly lower risk in 5-year oncologic recurrence (aHR 0.55, 95%CI 0.33-0.94, P=0.03) and higher 4-year survival (aHR 0.59, 95%CI 0.37-0.93, P=0.02) among patients with advanced cancer stage compared to pre-ERAS counterparts. ConclusionsPatients with advanced colorectal cancer were less likely to suffer oncologic recurrence when managed during the ERAS period. Additional prospective trials are necessary to determine causation and identify best practice principles associated with long-term recurrence and survival.

scholarly journals O20: PREOPERATIVE INTRAVENOUS IRON THERAPY AND SURVIVAL AFTER COLORECTAL CANCER SURGERY: LONG TERM RESULTS FROM THE INTRAVENOUS IRON IN COLORECTAL CANCER-ASSOCIATED ANAEMIA (IVICA) TRIAL

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
EA Dickson ◽  
BD Keeler ◽  
O Ng ◽  
A Kumar ◽  
MJ Brookes ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Intravenous Iron ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Free Survival ◽  
Disease Free

Abstract Background Intravenous iron is now the standard treatment to correct preoperative anaemia. However, iron may promote tumour growth and progression which could influence cancer recurrence and survival. We explore the long term postoperative outcomes of patients receiving oral (OI) or intravenous iron (IVI) as part of a randomised controlled trial. Method The multicentre IVICA trial randomised anaemic colorectal cancer patients in a 1:1 fashion to receive either OI or IVI prior to their elective operation. Follow up analysis of all patients was performed and Kaplan-Meier survival estimates and Cox proportional hazard models were used to compare groups. A pooled analysis comparing patients who did/did not achieve preoperative resolution of anaemia was also undertaken. Result, Data were available for 106 of the 116 IVICA patients (OI n=55, IVI n=51). Median follow up was 61 months (IQR 38-68, [range 1-80]). Overall survival estimates at 3 and 5 years were 82%(95% CI 76-90) and 72%(58-83) respectively for OI and 75%(61-86) and 59%(45-72) for IVI, P=0.106. No significant difference in 5-year overall survival (HR 1.73, 95% CI 0.90-3.34 P=0.102) or disease-free survival (HR 1.50, 95% CI 0.83-2.73 P=0.182) was observed between groups. Those non-anaemic at operation demonstrated improved 5 year overall survival (HR 3.26 [1.01-10.58], P=0.05). Non-significant trends in improved disease-free survival (HR 2.29 [0.91-5.81], p=0.08) were observed for the non-anaemic group Conclusion Preoperative correction of anaemia confers a postoperative survival advantage following elective colorectal cancer surgery. Due to its superior efficacy intravenous iron is recommended as the treatment of choice for this anaemia. Take-home message Preoperative correction of anaemia, achieved most effectively with intravenous iron, may offer improved long term postoperative survival after colorectal cancer surgery.

scholarly journals Increased long‐term mortality after open colorectal cancer surgery; a multicenter population‐based study

2021 ◽  
Author(s):  
Milad Fahim ◽  
Lea M. Dijksman ◽  
Thijs A. Burghgraef ◽  
Paul B. van der Nat ◽  
Wouter J.M. Derksen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Population Based ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Population Based Study ◽  
Long Term Mortality

scholarly journals Role of the intestinal microbiome in colorectal cancer surgery outcomes

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Lelde Lauka ◽  
Elisa Reitano ◽  
Maria Clotilde Carra ◽  
Federica Gaiani ◽  
Paschalis Gavriilidis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Surgery ◽  
Intestinal Microbiome ◽  
Colorectal Cancer Surgery ◽  
Microbiome Composition ◽  
Cancer Specific Mortality ◽  
Surgery Outcomes ◽  
Disease Free

Abstract Objectives Growing evidence supports the role of the intestinal microbiome in the carcinogenesis of colorectal cancers, but its impact on colorectal cancer surgery outcomes is not clearly defined. This systematic review aimed to analyze the association between intestinal microbiome composition and postoperative complication and survival following colorectal cancer surgery. Methods A systematic review was conducted according to the 2009 PRISMA guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Human studies investigating the association between the intestinal microbiome and the short-term (anastomotic leakage, surgical site infection, postoperative ileus) and long-term outcomes (cancer-specific mortality, overall and disease-free survival) of colorectal cancer surgery were selected. Patients with any stage of colorectal cancer were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. Results Overall, 8 studies (7 cohort studies and 1 case-control) published between 2014 and 2018 were included. Only one study focused on short-term surgical outcomes, showing that anastomotic leakage is associated with low microbial diversity and abundance of Lachnospiraceae and Bacteroidaceae families in the non-cancerous resection lines of the stapled anastomoses of colorectal cancer patients. The other 7 studies focused on long-term oncological outcomes, including survival and cancer recurrence. The majority of the studies (5/8) found that a higher level of Fusobacterium nucleatum adherent to the tumor tissue is associated with worse oncological outcomes, in particular, increased cancer-specific mortality, decreased median and overall survival, disease-free and cancer-specific survival rates. Also a high abundance of Bacteroides fragilis was found to be linked to worse outcomes, whereas the relative abundance of the Prevotella-co-abundance group (CAG), the Bacteroides CAG, and the pathogen CAG as well as Faecalibacterium prausnitzii appeared to be associated with better survival. Conclusions Based on the limited available evidence, microbiome composition may be associated with colorectal cancer surgery outcomes. Further studies are needed to elucidate the role of the intestinal microbiome as a prognostic factor in colorectal cancer surgery and its possible clinical implications.

Impact of deprivation on short- and long-term outcomes after colorectal cancer surgery

2011 ◽  
Vol 98 (6) ◽  
pp. 854-865 ◽  
Author(s):  
B. Bharathan ◽  
M. Welfare ◽  
D. W. Borowski ◽  
S. J. Mills ◽  
I. N. Steen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Surgery ◽  
Long Term Outcomes ◽  
Colorectal Cancer Surgery ◽  
Short And Long Term
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