The Association Between BMI and Nodal Harvest in Elective Colectomy for Colon Cancer

220 Background: Surgery for TNM Stage II colon cancer is considered curative however approximately 20% of patients will have recurrence of their disease. A number of high risk pathological features guide the use of adjuvant chemotherapy. More recently the preoperative SIR has been consistently shown to have prognostic value but to date has not been utilised clinically as a high risk feature. The present study compared the influence of the SIR versus established high-risk clinical features on overall/cancer specific survival (OS/CSS). Methods: Patients in the West of Scotland undergoing curative resection for Stage II colon cancer from 2011-2015 were identified with survival updated until December 2018. Additional data was obtained from online records. Through uni/multivariate analysis (UVA/MVA) we compared the effect on survival of the SIR measured using the modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) when entered individually into a multivariate model alongside established high-risk features. Results: 982 patients were identified having had a curative resection of Stage II colon cancer. Median follow up was 61 months and there were 307 deaths during follow up. For OS: emergency presentation, T stage, adjuvant chemotherapy, nodal harvest, margin involvement, mGPS, LMR, NLR (all p≤0.001) and EMVI (p < 0.05) were significant on UVA. On MVA: age (HR 1.51), T stage (HR 1.59), nodal harvest (HR 1.67), margin involvement (HR 1.94), adjuvant chemotherapy (HR 0.47), mGPS (HR 1.38), NLR (HR 1.35) and LMR (HR 1.50) remained significant (all p < 0.05). For CSS: age, emergency presentation, T stage, margin involvement, mGPS, NLR, LMR (all p < 0.001), nodal harvest and adjuvant chemotherapy (both p < 0.05) remained significant on UVA. On MVA emergency presentation (HR 1.88), T stage (HR 2.02), margin involvement (HR 2.98), adjuvant chemotherapy (HR 0.51) and mGPS (HR 1.34) remained significant (all p < 0.05). Conclusions: The present study suggests that the SIR is an independent predictor of worse OS/CSS in Stage II colon cancer and should be considered a high risk feature in future prospective studies.

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Predictors of Short-Term Postoperative Survival After Elective Colectomy in Colon Cancer Patients ≥80 Years of Age

Annals of Surgical Oncology ◽

10.1245/s10434-012-2721-8 ◽

2013 ◽

Vol 20 (5) ◽

pp. 1427-1435 ◽

Cited By ~ 48

Author(s):

Heather B. Neuman ◽

Jennifer M. Weiss ◽

Glen Leverson ◽

Erin S. O’Connor ◽

David Y. Greenblatt ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Postoperative Survival ◽

Short Term ◽

Elective Colectomy

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Impact of high-risk features on disease-free survival (DFS) in patients (pts) with high-risk stage II colon cancer (CC) in ACHIEVE-2 trial as part of the IDEA collaboration.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4011 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4011-4011

Author(s):

Dai Manaka ◽

Manabu Shiozawa ◽

Masahito Kotaka ◽

Makio Gamoh ◽

Akio Shiomi ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Vascular Invasion ◽

Disease Free Survival ◽

Stage Ii ◽

Free Survival ◽

Nodal Harvest ◽

Poorly Differentiated ◽

Stage Ii Colon Cancer ◽

Disease Free

4011 Background: The IDEA collaboration for high-risk stage 2 colorectal cancer patients (pts) demonstrated that for CAPOX, 3 months was non-inferior to 6 months treatment, while for FOLFOX, 6 months was superior to 3 months treatment. We investigated the impact of high risk features on disease-free survival (DFS). Methods: ACHIEVE-2, one of the 4 IDEA studies (SCOT, TOSCA, ACHIEVE-2, HORG), was an open-label, multicenter randomized trial for high-risk stage II colon cancer. High risk features are defined as one or more: T4, inadequate nodal harvest < 12, poorly differentiated, clinical sign of obstruction and perforation or vascular invasion. The association of high risk features with DFS were measured by Cox regression analyses. Results: Between 2014 and 2017, ACHIEVE-2 enrolled 525 pts, out of whom 514 pts were the modified ITT (mITT) population; 432 received CAPOX (84.0%) and 82 did mFOLFOX6 (16.0%). High-risk features included 35.8% of T4, 12.8% of inadequate nodal harvest, 11.5% of poorly differentiated, 19.3% of obstruction, 6.4% of perforation and 87.5% of vascular invasion; 47.3% had one features, 35.2% had two, 14.6% had three, and 2.9% had four or more. With a median follow-up of 36.1 months, 3-year DFS rates were 88% in both arms, with a hazard ratio (HR) of 1.12 (95% CI, 0.67-1.87, p=0.67). In multivariate analysis, T4 (HR 3.77 [2.18-6.53], p< 0.0001) and inadequate nodal harvest (HR 2.98 [1.59-5.59], p= 0.0006) remained independent significant negative prognostic factors. The 3-year DFS rates in T4 and Non-T4 diseases were 78% and 94% (p<0.0001), while 3-year DFS rate in pts with inadequate and adequate nodal harvest were 77% and 90% (p=0.0059). No interaction was observed between treatment duration and T4 or inadequate nodal harvest. Conclusions: Our findings indicated the relative impact of high risk features on DFS varies across factors; T4 and inadequate nodal harvest < 12 were more significant than the others. Our results must be interpreted within the combined analysis as well as within the reproducibility of results across the 4 trials. Clinical trial information: 000013036 .

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Elective laparoscopic colectomy in a patient 3 weeks after coronavirus disease 2019 infection: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02877-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yuki Tateno ◽

Kimito Harada ◽

Fumiki Okamoto ◽

Hideo Katsuragawa

Keyword(s):

Colon Cancer ◽

Laparoscopic Colectomy ◽

Sigmoid Colon Cancer ◽

Optimal Timing ◽

Computed Tomography Scan ◽

Case Presentation ◽

Elective Colectomy ◽

Tomography Scan ◽

Preoperative Examination ◽

Selection Of

Abstract Background According to previous reports, surgery is not recommended until at least 4 weeks after the symptoms of coronavirus disease 2019 resolve. However, strong evidence has not been established regarding the optimal timing and preoperative examination for elective laparoscopic colectomy for colorectal cancer in individuals with a previous coronavirus disease 2019 infection. Case presentation A 63-year-old Asian man underwent elective laparoscopic colectomy for sigmoid colon cancer 3 weeks after asymptomatic coronavirus disease 2019. The postoperative course was good, and none of the surgical staff was infected with coronavirus disease 2019. Conclusion In this patient infected with coronavirus disease 2019 within 4 weeks of surgery, preoperative venous ultrasound of the lower extremities and a chest computed tomography scan were useful examinations for ensuring a safe surgical procedure for the patient and the staff. Surgery within 4 weeks may be possible with careful selection of cases based on thorough preoperative examination. This report may contribute to the development of a consensus on performing safe elective colectomy for colon cancer in persons previously infected with coronavirus disease 2019.

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Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery

Cancers ◽

10.3390/cancers13071745 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1745

Author(s):

Nicolò Tamini ◽

Davide Bernasconi ◽

Lorenzo Ripamonti ◽

Giulia Lo Bianco ◽

Marco Braga ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Length Of Stay ◽

Postoperative Morbidity ◽

Predictive Ability ◽

Scoring Systems ◽

Comprehensive Complication Index ◽

Colon Cancer Surgery ◽

The Difference ◽

Elective Colectomy

(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien–Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%; 95%CI: 99.3–99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.

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