Increased Calcineurin A Expression Is Associated with a Lower Relapse-Free Survival Rate after Colorectal Cancer Surgery

784 Background: To date, reasons for adjuvant chemotherapy (AC) omission and delay have not been extensively studies. This study aimed to evaluate factors affecting chemotherapy use and delay (≥8 weeks) after colorectal cancer surgery and their impact on survival. Methods: Between 2008 and 2013, consecutive 584 patients undergoing major resection for stage II and III colorectal cancer in a single tertiary referral center. Results: Among 584 patients with stage II and III diseases, AC was performed in 460 (78.8%) patients. Regimens included fluorouracil with folinic acid (n=257, 55.9%), FOLFOX (n=134, 29.1%), capecitabline (n=62, 13.5%), and tegafur-uracil (n=7, 1.5%). Factors affecting not receiving AC were older age (>80 years), American Society of Anesthesiologists score (≥3), presence of postoperative complication, and not receiving preoperative chemoradiation. Overall survival was 87.2% (AC +) and 58.5% (no AC, p<0.001) in stage II disease, and 79.5% (AC +) and 24.6% (no AC, p<0.001) in stage III disease, respectively. Recurrence-free survival was 83.7% (AC +) and 61.9% (no AC, p=0.003) in stage II disease, and 60.5%(AC +) and 21.8% (no AC, p<0.001) in stage III disease, respectively. Among 460 patients undergoing AC, AC was initiated within 8 weeks in 438 patients (95.2%) and after 8 weeks in 22 patients (4.8%). Factors affecting AC delay were male gender, rectal primary, intraoperative blood loss (>100ml), and presence of postoperative complications. Overall survival was 90.8% (AC +) and 40.0% (no AC, p=0.111) in stage II disease, and 82% (AC +) and 35.6% (no AC, p=0.275) in stage III disease, respectively. Recurrence-free survival 80.1% (AC +) and 54.5% (no AC, p=0.133) in stage II disease, and 64.4% (AC +) and 0.0% (no AC, p=0.014), respectively. Conclusions: In stage II, III patients, it appears that use of AC is more closely related patient’s survival rather than the time of AC initiation. To improve oncologic outcomes after curative resection, it is important to increase the proporation of AC use.

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Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery

Annals of Coloproctology ◽

10.3393/ac.2019.10.15 ◽

2020 ◽

Vol 36 (4) ◽

pp. 273-280

Author(s):

Chang Kyu Oh ◽

Jung Wook Huh ◽

You Jin Lee ◽

Moon Suk Choi ◽

Dae Hee Pyo ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Postoperative Complications ◽

Survival Rates ◽

Disease Free Survival ◽

Major Complication ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Free Survival ◽

Disease Free

Purpose: The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.Methods: From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.Results: Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).Conclusion: Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

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THE ROLE OF BIOLOGICAL MARKERS IN THE DIAGNOSIS OF POSTOPERATIVE INFECTIONS IN COLORECTAL CANCER SURGERY (review)

Koloproktologia ◽

10.33878/2073-7556-2019-18-3-105-118 ◽

2019 ◽

Vol 18 (3(69)) ◽

pp. 105-118

Author(s):

S. I. Achkasov ◽

M. A. Sukhina ◽

A. I. Moskalev ◽

E. N. Nabiev

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Biological Markers ◽

Infectious Complications ◽

Cancer Surgery ◽

Postoperative Infections ◽

Colorectal Cancer Surgery ◽

Free Survival

Infectious complications in colorectal cancer surgery is one of the major problems in postoperative complications structure. The frequency of the latter is 5-22%, and in 5-20% of cases such complications lead to death. It should be noted that the development of postoperative complications leads to a decrease in the quality of life of patients, general and relapse-free survival of patients operated on for colorectal cancer. One of the promising ways to diagnose postoperative infectious complications after surgery is to assess the level of biological markers of plasma inflammation. It can be used to identify patients with a high probability of infection and be an indication for earlier additional methods of diagnosing complications. Currently, biomarkers that are used for early postoperative infection detection include increase in the leukocytes level in peripheral blood, CRP, PCT, CD64 neutrophils and others. Despite the large number of studies, the question of the role of these biomarkers in postoperative infections diagnosis in the patients who under went colorectal cancer surgery remains unclear.

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A Preoperative Neutrophil to Lymphocyte Ratio of 3 Predicts Disease-Free Survival After Curative Elective Colorectal Cancer Surgery

Annals of Surgery ◽

10.1097/sla.0000000000000216 ◽

2014 ◽

Vol 260 (2) ◽

pp. 287-292 ◽

Cited By ~ 83

Author(s):

George Malietzis ◽

Marco Giacometti ◽

Alan Askari ◽

Subramanian Nachiappan ◽

Robin H. Kennedy ◽

...

Keyword(s):

Colorectal Cancer ◽

Disease Free Survival ◽

Cancer Surgery ◽

Neutrophil To Lymphocyte Ratio ◽

Colorectal Cancer Surgery ◽

Free Survival ◽

Lymphocyte Ratio ◽

Disease Free

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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

British Journal of Surgery ◽

10.1093/bjs/znab117.020 ◽

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.

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The Feasibility and Long Term Clinical Outcome of Laparoscopic Colorectal Cancer Surgery in the Rural Healthcare Setting - A Western Australian Experience

10.37191/mapsci-jasr-1(1)-001 ◽

2020 ◽

Author(s):

Abdallah Elsabag

Keyword(s):

Colorectal Cancer ◽

Local Recurrence ◽

Western Australia ◽

Disease Free Survival ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Free Survival ◽

Western Australian ◽

Disease Free

Objective: Laparoscopic colorectal cancer (CRC) surgery has increasingly become the standard of care world-wide. However, the availability within the rural Western Australian setting remains heterogenous and the long term outcome is largely unknown. This study reviews our experience and 5 year outcomes in laparoscopic colorectal cancer surgery (CRC) in a major rural surgical unit in Western Australia. Materials and Methods: This is a retrospective study based in Albany Regional Hospital, Western Australia. All patients who underwent elective laparoscopic colorectal surgery for cancer by a single surgeon over a five-year period (2007- 2012) were included. All case records were reviewed. All cases had been discussed in multidisciplinary meeting and recommendations were followed in regards to staging modalities and / or neo-adjuvant and adjuvant treatments. Patients were followed up in the surgical clinic six monthly with serial CEA and a yearly CT Chest, abdomen and pelvis and colonoscopy as per guidelines, thereafter they were discharged for GP follow. The primary outcomes were local recurrence, metastatic disease, five year disease free survival, anastomotic stricture, incisional hernia and small bowel obstruction. Results: Sixty-seven patients were reviewed. Two required conversion to open (3%) and were not considered further. A total of 65 patients were included (30 male, mean age: 69 years). The most common site of tumour was at the ascending colon which comprised of 38% of all cases. The mean operating time was 161 minutes. Five year disease free survival was 97%, no Local recurrence of anastomotic strictures were detected in our study, The overall cancer related mortality was one case out of the 65 cases. Conclusions: Laparoscopic colorectal cancer surgery is safe and feasible in the rural Western Australian setting with comparable 5 year outcomes with international literature. Provided this is performed by appropriately trained general surgeons with suitable case selection.

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Impact of infectious complications on long-term survival following colorectal cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.531 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 531-531

Author(s):

Ali Mokdad ◽

Hannah Hirsch ◽

Ibrahim Nassour ◽

Nicholas Borja ◽

Glen C. Balch ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Multivariable Analysis ◽

Infectious Complications ◽

Cancer Surgery ◽

Recurrence Free Survival ◽

Colorectal Cancer Surgery ◽

Term Survival ◽

Free Survival

531 Background: Colorectal cancer surgery is associated with significant postoperative morbidity, which may have long-term implications on patient outcomes. We hypothesize that operative complications following surgery for colorectal cancer are associated with increased recurrence and worse survival. Methods: Using a prospectively maintained database, we reviewed patients with colorectal cancer that underwent a curative resection from 2008 to 2015. Patients were categorized by presence of any complication within 90 days from surgery and by type of complication, infectious and non-infectious. We compared clinical, pathological, and perioperative data using t-test, chi-squared test, and ANOVA. We compared overall (OS) and recurrence free survival (RFS) using Kaplan Meier and log-rank test. Multivariable Cox regression was used to compare mortality and recurrence. Results: Two hundred and twenty-nine patients underwent 104 colon and 125 rectal cancer resections (20 pelvic exenterations, 83 low anterior and 17 abdominoperineal resections) were followed for a median of 23 months. Fifty percent were completed minimally invasively. Postoperative complications occurred in 52%; 19% had a major complication (Clavien-Dindo 3-4). Postoperative complications were more likely to occur in open (61% vs. 38%, p < 0.01) and rectal operations (63% vs. 42%, p = 0.02). On multivariable analysis, OS and RFS were not statistically different in patients with complications. Patients with infectious complications had worse 3-year survival when compared to patients with non-infectious complications and without complications (58%,69%,76%, p = 0.04). Recurrence at 3 years was also significantly different among the three groups (p = 0.03). Infectious complications remained associated with worse overall survival (HR 1.8; 95% CI 1.02,3.26) and recurrence free survival (HR 1.9; 95% CI 1.06,3.39) after adjusting for patient, tumor, and perioperative data. Conclusions: Infectious complications following colorectal cancer surgery are associated with worse OS and RFS independent of tumor stage, type of surgery, and technique. Current research is ongoing to explore possible etiologies of this association.

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