scholarly journals Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

2021 ◽  
Author(s):  
Petrus Boström ◽  
Johan Svensson ◽  
Camilla Brorsson ◽  
Martin Rutegård
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Population Based ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

scholarly journals Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yu Yang ◽  
Yuxuan Li ◽  
Xiaohui Du
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Anastomotic Leakage ◽  
Incidence Rate ◽  
Intraperitoneal Chemotherapy ◽  
Meta Analysis ◽  
Abdominal Cavity ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Increased Risk

Purpose. To identify and evaluate the influence of intraperitoneal chemotherapy without hyperthermia (ICwh) to the incidence of anastomotic leakage (AL) after colorectal cancer surgery. Methods. A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses in order to review all studies investigating the relationship between ICwh and AL in patients undergoing colorectal surgery. The primary outcome was overall incidence rate of anastomotic leakage. Results. Four studies were included in the final review. ICwh was associated with an overall increased risk of anastomotic leakage [OR 2.05 (1.06, 3.98), P = 0.03 ]. But there was no significant increased incidence rate when fluorouracil was implanted into the abdominal cavity for ICwh [OR 2.48 (0.55, 11.10), P = 0.24 ]. Conclusions. This meta-analysis provides some evidence to suggest ICwh may increase the incidence of postoperative AL in colorectal cancer. However, fluorouracil implantation for ICwh does not increase the risk of AL, which seems to be a relatively safe method of ICwh.

Morbidity and mortality after colorectal cancer surgery in patients with cirrhosis: A critical review of the literature.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 608-608
Author(s):  
Tarek Boussaha ◽  
Jean François Cadranel ◽  
Allaoua Smail ◽  
Hortensia Lison ◽  
Armand Garioud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Independent Risk Factors

608 Background: Cirrhotic patients with localized colorectal cancer are potential candidates for tumor resection. The aim of this review was to evaluate the morbi-mortality after colorectal surgery. Methods: Comprehensive search was conducted using PUBMED, EMBASE, and the COCHRANE Library. Prospective and retrospective studies were selected. The study population included cirrhotic patients who underwent colorectal resection for non-metastatic colorectal cancer and patients with benign and other malignant disease. The postoperative morbi-mortality and independent risk factors were analysed. Results: Eight studies were identified. Among these, four studies compared the risk of colorectal surgery in patients with and without liver cirrhosis. The number of patients varied from 41 to 6,120. The severity of cirrhosis in most of the studies was classified with the Child-Pugh score. Class B and C were observed in 20% to 60% of the patients. Sepsis represented the main postoperative complication and occurred in 48% to 77% of patients. Mortality varied according to the Child-Pugh score, ranging from 11% to 41%, and was significantly higher for patients with cirrhosis in Child-Pugh Class C. Urgent surgical procedure had a negative impact on prognosis. The average length of hospital stay ranged from 9 to 18 days. Cirrhosis was associated with a 2-3 time and a 4-10 time increased risk of postoperative mortality in the absence and presence of portal hypertension, respectively compared with non-cirrhotic patients. The independent risk factors for postoperative morbidity and mortality were encephalopathy, ascites, low haemoglobin, prolonged prothrombin time, elevated bilirubin, hypoalbuminemia, postoperative infection, total colectomy, elective or non-elective surgery, the presence of co-morbidities and MELD score ≥ 15. Conclusions: Colorectal cancer surgery is associated with an increased risk of postoperative morbidity and mortality in cirrhosis patients. Studies evaluating exclusively the operative risk for colorectal cancer surgery in this patient’s population are rare. Prospective controlled trials to optimize the perioperative management of those patients are needed.

scholarly journals Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011‐2019), a Dutch population based study

2021 ◽  
Author(s):  
Melissa N.N. Arron ◽  
Nynke G. Greijdanus ◽  
Richard P.G. ten Broek ◽  
Jan Willem T. Dekker ◽  
Frans van Workum ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Anastomotic Leakage ◽  
Population Based ◽  
Cancer Surgery ◽  
Dutch Population ◽  
Colorectal Cancer Surgery ◽  
Population Based Study

scholarly journals Evaluation of the inflammatory markers CCL8, CXCL5, and LIF in patients with anastomotic leakage after colorectal cancer surgery

2020 ◽  
Vol 35 (7) ◽  
pp. 1221-1230 ◽  
Author(s):  
F. Klupp ◽  
S. Schuler ◽  
C. Kahlert ◽  
N. Halama ◽  
C. Franz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Protein Expression ◽  
Anastomotic Leakage ◽  
Peritoneal Fluid ◽  
Inflammatory Markers ◽  
Expression Profiles ◽  
Expression Patterns ◽  
Predictive Biomarkers ◽  
Colorectal Cancer Surgery

Abstract Purpose Anastomotic leakage constitutes a dreaded complication after colorectal surgery, leading to increased morbidity and mortality as well as prolonged hospitalization. Most leakages become clinically apparent about 8 days after surgery; however, early detection is quintessential to reduce complications and to improve patients’ outcome. We therefore investigated the significance of specific protein expression profiles as putative biomarkers, indicating anastomotic leakage. Methods In this single-center prospective cohort study serum and peritoneal fluid samples—from routinely intraoperatively inserted drainages—of colorectal cancer patients were collected 3 days after colorectal resection. Twenty patients without anastomotic leakage and 18 patients with an anastomotic leakage and without other complications were included. Protein expression of seven inflammatory markers in serum and peritoneal fluid was assessed by multiplex ELISA and correlated with patients’ clinical data. Results Monocyte chemoattractant protein 2 (CCL8/MCP-2), leukemia-inhibiting factor (LIF), and epithelial-derived neutrophil-activating protein (CXCL5/ENA-78) were significantly elevated in peritoneal fluid but not in serum samples from patients subsequently developing anastomotic leakage after colorectal surgery. No expressional differences could be found between grade B and grade C anastomotic leakages. Conclusion Measurement 3 days after surgery revealed altered protein expression patterns of the inflammatory markers CCL8/MCP2, LIF, and CXCL5/ENA-78 in peritoneal fluid from patients developing anastomotic leakage after colorectal surgery. Further studies with a larger patient cohort with inclusion of different variables are needed to evaluate their potential as predictive biomarkers for anastomotic leakage.

The effect of age on anastomotic leakage in colorectal cancer surgery: A population-based study

2018 ◽  
Vol 118 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Ina Zaimi ◽  
Cloë L. Sparreboom ◽  
Hester F. Lingsma ◽  
Pascal G. Doornebosch ◽  
Anand G. Menon ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Anastomotic Leakage ◽  
Population Based ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Population Based Study ◽  
Effect Of Age

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

scholarly journals Su1228 Increased Risk of Colorectal Cancer in Patients With Prior Ovarian Cancer Diagnosis: A Population Based US Study

2014 ◽  
Vol 146 (5) ◽  
pp. S-408
Author(s):  
Yezaz A. Ghouri ◽  
Sachin Batra ◽  
Nirav C. Thosani ◽  
Sushovan Guha
Keyword(s):  
Colorectal Cancer ◽  
Ovarian Cancer ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Increased Risk

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
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