Tu1760 Neutrophil Count, but Not Other Components of a White Cell Count, Reflects the Impact of the Systemic Inflammatory Response and Long Term Survival in Patients Following Elective Surgery for Colorectal Cancer

2015 ◽  
Vol 148 (4) ◽  
pp. S-1175
Author(s):  
David G. Watt ◽  
James H. Park ◽  
Michelle L. Ramanathan ◽  
Paul G. Horgan ◽  
Donald C. McMillan
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Response ◽  
Cell Count ◽  
Neutrophil Count ◽  
Elective Surgery ◽  
White Cell Count ◽  
Systemic Inflammatory Response ◽  
Term Survival ◽  
The Impact

The impact of preoperative dexamethasone on the postoperative systemic inflammatory response and complications following surgery for colorectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 692-692
Author(s):  
Stephen Thomas McSorley ◽  
Paul G. Horgan ◽  
Donald C McMillan
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Inflammatory Response ◽  
Elective Surgery ◽  
Systemic Inflammatory Response ◽  
Curative Surgery ◽  
Association Table ◽  
L 14 ◽  
Induction Of Anaesthesia ◽  
The Impact

692 Background: It is now clear that there is a significant association between the magnitude of the systemic inflammatory response and postoperative complications (Adamina et al. Br J Surg 2015;102(6):590-8). The present study examined the impact of preoperative steroids on the postoperative systemic inflammatory response and complications, following elective surgery for colorectal cancer. Methods: The administration of dexamethasone at induction of anaesthesia was prospectively audited from a cohort of patients who underwent elective, potentially curative surgery for colorectal cancer at a single centre between 2008 and 2013. Results: 286 patients were included, of which the majority were male (161, 57%), over 65 (190, 66%) with colonic (183, 64%) and node negative disease (192, 67%). 114 (40%) received dexamethasone at induction of anaesthesia. There was a significant association (Table 1) between preoperative dexamethasone administration and the proportion of patients breaching established CRP thresholds on postoperative days 2 (190mg/L, 14% vs. 50%, p<0.001), and 3 (170mg/L, 27% vs. 49%, p<0.001) but not 4 (145mg/L, 50% vs. 36%, p=0.658). There was no significant association between preoperative dexamethasone and postoperative complications. Conclusions: The present study suggests that the systemic inflammatory response following surgery for colorectal cancer may be attenuated by preoperative steroids. It remains to be determined whether this will lead to a reduction in postoperative complications. [Table: see text]

The impact of preoperative dexamethasone on long-term survival following surgery for colorectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 644-644
Author(s):  
Stephen Thomas McSorley ◽  
Bo Khor ◽  
Campbell SD Roxburgh ◽  
Paul G. Horgan ◽  
Donald C McMillan
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Cox Regression ◽  
Elective Surgery ◽  
Matched Cohort ◽  
Curative Intent ◽  
Term Survival ◽  
Negative Effect ◽  
The Impact

644 Background: Steroids given at the induction of anaesthesia are associated with a reduction in the magnitude of the postoperative systemic inflammatory response and fewer complications following elective surgery for colorectal cancer (McSorley et al. Ann Surg Oncol 2017;24(8):2104-2112). The present study examined their impact on survival. Methods: Patients who underwent elective surgery, with curative intent, for stage I-III colorectal cancer at a single centre between 2008 and 2016 were included. Data on preoperative dexamethasone was obtained from anaesthetic records, and its impact on cancer specific (CSS) and overall survival (OS) assessed using Cox regression in an unmatched (n=556) and a propensity score matched cohort (n=276) (Table 1). Results: After excluding postoperative mortalities (n=3), there were 98 deaths (18%), with 57 (10%) due to cancer. Of those alive at censoring, the median follow up was 47 months (range 16-110). In the unmatched cohort, there was no significant association between dexamethasone and CSS (HR 0.90, 95% CI 0.52-1.53, p=0.688) or OS (HR 0.95, 95% CI 0.63-1.43, p=0.804). In the propensity score matched cohort, there was no significant association between dexamethasone and CSS (HR 1.18, 95% CI 0.55-2.53, p=0.668) or OS (HR 1.21, 95% CI 0.67-2.17), p=0.532). Conclusions: These results suggest that whilst preoperative steroids are associated with improved short term outcomes following surgery for colorectal cancer, they have no negative effect on long term outcomes. [Table: see text]

Does pre-operative aspirin and statin prescription modulate the post-operative systemic inflammatory response following surgery for colorectal cancer?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 596-596 ◽  
Author(s):  
David G. Watt ◽  
James Hugh Park ◽  
Shoukee K Ng ◽  
Paul G. Horgan ◽  
Donald C McMillan
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Response ◽  
Elective Surgery ◽  
Systemic Inflammatory Response ◽  
Current Evidence ◽  
Reactive Protein ◽  
Statin Prescription ◽  
Short And Long Term ◽  
The Relationship

596 Background: Aspirin use has been reported to reduce the pre-op systemic inflammatory response (SIR) in patients with colorectal cancer (CRC). Moreover, an exaggerated post-op SIR, evidenced by C-reactive protein (CRP) concentrations, is associated with poorer short and long term outcomes, highlighting the importance of CRP as a potential therapeutic target for improving outcomes following surgery for CRC. Drugs such as corticosteroids, aspirin and statins may modulate the post-op SIR, but there is little current evidence supporting this hypothesis. Therefore, the aim of the present study was to determine whether pre-op prescription of aspirin or statins modulated the post-op SIR in patients undergoing surgery for CRC. Methods: Included patients were obtained from a prospectively maintained database of CRC resections from a single institution (2010-2014). The relationship between pre-op aspirin and statin prescription and post-op CRP concentrations was examined. Results: 446 patients were included. The majority of patients were > 65 yrs (64%), male (57%) and underwent elective surgery (91%). 120 patients were prescribed aspirin and 187 prescribed statins with 100 patients prescribed both. Patients prescribed aspirin had a reduced post-op SIR particularly on day 3 (p = 0.009), 4 (p = 0.003) and 5 (p = 0.005). This effect was also observed following elective surgery (n = 402) on day 3 (p = 0.014), day 4 (p = 0.009) and day 5 (p = 0.019). Patients prescribed a statin also had a reduced post-op SIR, particularly on days 3 (p = 0.010), 4 (p = 0.006) and 5 (p = 0.017) and also following elective surgery on day 3 (p = 0.039) and day 4 (p = 0.039). The combination of aspirin and statin, compared with none or each on its own, resulted in the lowest post-op SIR, particularly on day 3 (p = 0.015), day 4 (p = 0.006) and day 5 (p = 0.023). Conclusions: Pre-op prescription of aspirin or statins resulted in a reduced post-op SIR following surgery for CRC. Therefore, pre-op use of these medications may be of benefit in improving outcomes, by reducing the post-op SIR – a reported predictor of both long and short term outcomes, following surgery for CRC.

The impact of skeletal muscle and adipose tissue on long-term survival in patients with resectable colorectal cancer.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 3585-3585
Author(s):  
Michael B. Sawyer ◽  
Jessica Hopkins ◽  
Rebecca Reif ◽  
David Bigam ◽  
Vickie E. Baracos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

scholarly journals Impact of Frailty On 5-Year Survival In Patients Older Than 70 Years Undergoing Colorectal Surgery for Cancer

2021 ◽  
Author(s):  
Manuel Artiles-Armas ◽  
Cristina Roque-Castellano ◽  
Roberto Fariña-Castro ◽  
Alicia Conde-Martel ◽  
María Asunción Acosta-Mérida ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Univariate Analysis ◽  
Cognitive Status ◽  
Tnm Stage ◽  
Term Survival ◽  
Long Term Survival ◽  
Operative Outcomes ◽  
Frail Patients ◽  
The Impact

Abstract Background: Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyse the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients.Methods: A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CSF) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumour extent, and post-operative outcomes, which were mortality at 30 days, 90 days and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival.Results: Out of the 149 patients, 96 (64.4%) were men and 53 (35.6) were women, with a median age of 75 years (IQR: 72-80). According to the CSHA-CSF scale, 59 patients (39.6%) were frail, and 90 patients (60.4%) were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p=0.001); the Lawton-Brody Index (p=0.011); failure to perform an anastomosis (p=0.024); nodal involvement (p=0.005); distant metastases (p<0.001); high TNM stage (p=0.004); and anastomosis dehiscence (p=0.013) were significant univariate predictors of a poor prognosis in univariate analysis. Multivariate analysis (Cox regression) of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p=0.002; HR:1.30; 95% CI:1.10–1.54) and TNM stage (p=0.014; HR:2.06; 95% CI:1.16-3.67) were the only independent risk factors for survival at five years.Conclusions: Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in patients with colorectal cancer. Instead, comorbidities and tumour stage are good predictors of long-term survival.

scholarly journals Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

2020 ◽  
Author(s):  
Marius Kryzauskas ◽  
Augustinas Bausys ◽  
Austeja Elzbieta Degutyte ◽  
Vilius Abeciunas ◽  
Eligijus Poskus ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Rectal Resection ◽  
Multivariable Analysis ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Male Sex ◽  
The Impact

Abstract Background: Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.Methods: Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified and long-term outcomes of patients with and without AL were compared.Results: AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III-IV; OR=10.54, p=0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR=2.40, p=0.004), CCI score >5 (OR=1.72, p=0.025) and T3/T4 stage tumors (OR=2.25, p=0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p=0.009 and p=0.001) and rectal (p=0.003 and p=0.014) surgery.Conclusion: ASA score of III-IV is an independent risk factor for AL after sigmoid surgery and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

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