30-Day Postoperative Morbidity of Emergency Surgery for Obstructive Right- and Left-Sided Colon Cancer in Obese Patients: A Multicenter Cohort Study of the French Surgical Association

Background: Emergency surgery impairs postoperative outcomes in colorectal cancer patients. No study has assessed the relationship between obesity and postoperative results in this setting. Objective: To compare the results of emergency surgery for obstructive colon cancer (OCC) in an obese patient population with those in overweight and normal weight patient groups. Methods: From 2000 to 2015, patients undergoing emergency surgery for OCC in French surgical centers members of the French National Surgical Association were included. Three groups were defined: normal weight (body mass index [BMI] < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Results: Of 1,241 patients, 329 (26.5%) were overweight and 143 (11.5%) were obese. Obese patients had significantly higher American society of anesthesiologists score, more cardiovascular comorbidity and more hemodynamic instability at presentation. Overall postoperative mortality and morbidity were 8 and 51%, respectively, with no difference between the 3 groups. For obese patients with left-sided OCC, stoma-related complications were significantly increased (8 vs. 5 vs. 15%, p = 0.02). Conclusion: Compared with lower BMI patients, obese patients with OCC had a more severe presentation at admission but similar surgical management. Obesity did not increase 30-day postoperative morbidity except stoma-related complications for those with left-sided OCC.

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Prognostic impact of body mass index upon cancer recurrence and survival in stage III colon cancer patients from adjuvant chemotherapy trials

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.11088 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 11088-11088

Author(s):

F. Sinicrope ◽

N. R. Foster ◽

D. J. Sargent ◽

S. R. Alberts ◽

M. J. O'Connell

Keyword(s):

Colon Cancer ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Normal Weight ◽

Stage Iii ◽

Obese Patients ◽

Tumor Site ◽

Free Survival ◽

Stage Iii Colon Cancer ◽

Disease Free

11088 Background: Obesity is associated with an increased risk of colon cancer. However, the influence of body mass index (BMI) upon the prognosis of patients with established colon cancer remains unknown. Methods: We conducted a retrospective study of 1,803 patients with surgically resected stage III colon cancer who were enrolled in five randomized trials of 5-fluorouracil-based adjuvant chemotherapy conducted by the North Central Cancer Treatment Group. Patient height and weight were recorded at study entry and BMI (kg/m2) was calculated and categorized. Cancer recurrence or death were monitored during 5 years of follow-up. The score and likelihood ratio p-values were determined from univariate and multivariate Cox regression models respectively, after stratifying by study. Results: Among stage III colon cancer patients, 19% were obese (BMI 30 kg/m2), 37% were overweight (BMI, 25 to 29.9 kg/m2), 38% were of normal-weight (BMI, 20 to 24.9 kg/m2), and 6% were underweight (BMI < 20 kg/m2). Obese versus normal-weight patients showed higher rates of lymph node (LN) metastasis (>3 LNs; 38% vs. 29%, p <0.01) and tumor site was more likely to be distal versus proximal (52% vs. 45%, p= 0.03). No differences in age, gender, or histologic grade were found. In a univariate analysis, obese patients had significantly worse disease-free survival (DFS) compared with normal-weight patients (hazard ratio 1.25 (95% CI: 1.04 -1.51; p= 0.02). The 5 year DFS rates were 49% in obese patients versus 57% in normal weight subjects. Furthermore, poorer DFS was observed for obese patients after adjusting for age, sex, histologic grade, and tumor site (p= 0.03). Neither overweight nor underweight patients (vs. normal-weight) had significantly different DFS. Analysis of the predictive impact of BMI for 5-FU-based adjuvant therapy is in progress. Conclusions: Obesity (BMI 30 kg/m2) was associated with a greater number of metastatic lymph nodes and poorer disease-free survival in patients with stage III colon cancer, suggesting that obesity influences tumor progression. No significant financial relationships to disclose.

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The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

Digestive Surgery ◽

10.1159/000489826 ◽

2018 ◽

Vol 36 (4) ◽

pp. 323-330 ◽

Cited By ~ 2

Author(s):

Kosei Takagi ◽

Yuzo Umeda ◽

Ryuichi Yoshida ◽

Daisuke Nobuoka ◽

Takashi Kuise ◽

...

Keyword(s):

Risk Factors ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Postoperative Morbidity ◽

Postoperative Mortality ◽

Elderly Group ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Propensity Score Matching Analysis

Background/Aims: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. Methods: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. Results: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). Conclusions: Although elderly patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

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High Neutrophil to Lymphocyte Ratio Is Associated With Symptomatic and Ruptured Thoracic Aortic Aneurysm

Angiology ◽

10.1177/0003319717751758 ◽

2018 ◽

Vol 69 (8) ◽

pp. 686-691 ◽

Cited By ~ 10

Author(s):

Fabien Lareyre ◽

Juliette Raffort ◽

Duy Le ◽

Hon Lai Chan ◽

Thomas Le Houerou ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Postoperative Morbidity ◽

Surgical Repair ◽

Postoperative Mortality ◽

Postoperative Outcome ◽

Neutrophil To Lymphocyte Ratio ◽

Mortality And Morbidity ◽

Lymphocyte Ratio ◽

Significant Difference

The predictive value of the neutrophil to lymphocyte ratio (NLR) has been demonstrated in several cardiovascular diseases. The aim of our study was to investigate the association between the preoperative NLR and aneurysm characteristics as well as 30-day postoperative morbidity and mortality in patients with thoracic aortic aneurysm (TAA) undergoing aortic surgical repair. Consecutive patients (n = 75) with TAA were retrospectively included over a 10-year period. Clinical characteristics, aneurysm characteristics, and 30-day postoperative outcome were recorded. The median age of patients was 71 (67-80) years. The median preoperative NLR was 3.5 (2.3-5.8). The proportion of asymptomatic TAA was significantly lower in patients with an NLR > 3.5 compared with those with an NLR < 3.5 (52.6% vs 75.7%; P = .054). The proportion of patients with pain or with ruptured TAA was significantly higher in patients with an NLR > 3.5 compared with those with NLR < 3.5 (42.1% vs 16.2%; P = .022 and 26.3% vs 2.7%; P = .007, respectively). No significant difference was observed regarding the 30-day overall postoperative mortality and morbidity. The preoperative NLR did not correlate with TAA diameter. A high preoperative NLR is significantly associated with symptomatic and ruptured TAA, suggesting a potential interest as a marker and/or player in the disease.

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Neuraxial Anesthesia and Postoperative Mortality and Morbidity

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0042 ◽

2018 ◽

pp. 225-229

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Postoperative Morbidity ◽

Postoperative Mortality ◽

Mortality And Morbidity ◽

Neuraxial Blockade ◽

Study Results ◽

Wide Range

This case focuses on the effects of neuraxial blockade on postoperative mortality and morbidity by asking the question: What are the effects of neuraxial blockade with epidural or spinal anesthesia on postoperative morbidity and mortality? This systematic review examined all trials with randomization to intraoperative neuraxial blockade (with epidural or spinal anesthesia) or no neuraxial blockade for which data were available before January 1, 1997. The study included 9,559 patients over 141 included trials. Study results demonstrated that neuraxial blockade reduces morbidity and postoperative complications in a wide range of patients, independent of surgery type, choice of neuraxial technique, or use of general anesthesia.

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Frailty and emergency surgery in the elderly: Protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

F1000Research ◽

10.12688/f1000research.12030.1 ◽

2017 ◽

Vol 6 ◽

pp. 1162

Author(s):

Gianluca Costa ◽

Giulia Massa ◽

Genoveffa Balducci ◽

Barbara Frezza ◽

Pietro Fransvea ◽

...

Keyword(s):

Outcome Measures ◽

Emergency Surgery ◽

Postoperative Mortality ◽

Risk Scores ◽

Secondary Outcome ◽

Aged Patients ◽

Term Outcome ◽

Surgical Risk ◽

Mortality And Morbidity ◽

Multicenter Observational Study

Introduction: Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinico-pathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. Methods and analysis: The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system will be used to categorize complications. Secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and the predictive value for morbidity and mortality of several frailty and surgical risk scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02825082).

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CARDIOVASCULAR PARAMETERS IN OBESE AND NORMAL WEIGHT PEOPLE: A COMPARATIVE STUDY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i4.1442 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Arti Gupta (Bansal)

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Strong Association ◽

Obese Subject ◽

Obese Individual ◽

Normal Weight ◽

Overweight And Obesity ◽

World Health ◽

Obese Patients ◽

Mortality And Morbidity

Introduction: Obesity can be classified as generalized obesity (GO) and abdominal obesity (AO) and obese population have higher rates of mortality and morbidity compared to non-obese individuals. World Health Organization (WHO) has defined overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health. A commonly used simple measure to classify overweight and obesity in adults is body mass index (BMI). BMI is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). WHO defines overweight when BMI is greater than or equal to 25; and obesity when BMI is greater or equal to 30 but in Asians, the cut-offs for overweight (≥23.0kg/m2) and obesity (≥25.0kg/m2) are lower than WHO criteria due to risk factors and morbidities MATERIAL AND methods: A sample of 50 male and 50 female obese patients with body Mass Index > 30 kg/m2 and also 50 male and 50 female non obese patients with body Mass Index of 18.50 – 24.99 kg/m2 were selected. Sample was randomly selected. A pilot study was carried out on 20 patients to ensure feasibility, and time needed for completing the study. Results: A total of 200 participants were included in the study of which 100 were obese and 100 were non obese subject. Comparison of cardiac paramenters between obese and non obese individual was done like hrart rate, systolic and diastolic blood pressure, mean arterial pressure and pulse pressure. Demographic variables were also compared. Conclusion: The strong association of obesity with cardiovascular disease necessitates the importance of prevention and control of obesity and it should begin in early child hood also proper diet and regular medical check-up should be carried out to cope up with the problem of obesity.

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Role of surgical resection in treatment of pancreatic adenocarcinoma

Medicinski pregled ◽

10.2298/mpns1110448m ◽

2011 ◽

Vol 64 (9-10) ◽

pp. 448-452 ◽

Cited By ~ 1

Author(s):

Pavle Milosevic ◽

Matilda Djolaji ◽

Djordje Milosevic ◽

Nada Ikonic ◽

Ana Popovic ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Surgical Resection ◽

Postoperative Morbidity ◽

Therapeutic Option ◽

Postoperative Mortality ◽

The Body ◽

Morbidity Rate ◽

Mortality And Morbidity ◽

Average Survival ◽

Clinical Center

Introduction. Pancreatic adenocarcinoma is the fifth leading cause of death from malignant diseases. The total five-year rate is bellow 5%, but in patients who underwent pancreatic resection, the fiveyear rate may be up to 20%. Surgical resection is still the only therapeutic option that offers the possibility of cure. In recent decades, the perioperative mortality rate has been significantly reduced in the institutions performing a number of these operations per year and has become less than 5%. Postoperative morbidity remains high. Material and Methods. The results of surgical resection in the treatment of pancreatic adenocarcinoma have been analyzed. A retrospective study included the patients operated at the Department for Abdominal, Endocrine and Transplantation surgery, Clinical Center of Vojvodina. Results. In the period from February 1st 1998 to February 1st 2007 a total of 67 patients with pancreatic adenocarcinoma underwent resection. The average age of patients was 58.81?1.42 years. There were 44 (65.7%) male and 23 (34.3%) female patients. The most common locations of cancer were the head, then the body and the tail of the pancreas and they were found in 57 (85.1%) cases, 7 (10,4%) cases and 3 (4,47%) cases, respectively. The postoperative mortality appeared in 3 (4.47%) cases and postoperative morbidity in 21 (31.3%) cases. The average survival was 22.89? 3.87 months, the median being 9.0?2.18 months. The five-year survival rate was 13.5%. Conclusion. For patients with pancreatic cancer, surgical resection still remains the only chance of cure. These procedures are performed with acceptable postoperative mortality and morbidity rate. The percentage of cured patients is still unsatisfactorily low.

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Obesity and peritoneal surface disease: Outcomes following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.533 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 533-533

Author(s):

Konstantinos I Votanopoulos ◽

Katrina R Swett ◽

Doug S Swords ◽

Perry Shen ◽

John Stewart ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Low Grade ◽

Obese Patients ◽

Term Survival ◽

Peritoneal Surface ◽

Resection Status ◽

Primary Colon ◽

Survival Differences

533 Background: It is estimated that 35% of the US population is obese. It is unknown how obesity influences the operative and survival outcomes of CRS/HIPEC procedures. Methods: A retrospective analysis of a prospective database of 1,000 procedures was performed. Type of malignancy, ECOG, resection status, hospital and ICU stay, Clavien-Dindo morbidity, mortality and survival were reviewed. Results: 242 patients with BMI>30 (30-63.3) underwent 264 CRS/HIPEC procedures between 1991-2012. 94(38.8%) of those had a BMI>35. 136(51.7%) obese patients had appendiceal and 59(22.4%) colon cancer. Median follow up for obese patients was 52 months. Major (III /IV) and minor morbidity (I/II) was 36.6% and 28.8% for obese and 36.5% and 25.7% for non-obese patients. The 30 day mortality for obese and non-obese was 5.5% and 7.3% respectively. Median ICU and hospital stay was 1 and 9 days for both obese and non-obese. The 30 day readmission rate was similar between obese and non-obese patients 35.2% vs 30.8%. When patients were grouped by primary (colon or appendix), resection status, and grade of disease (for appendiceal) and stratified by BMI (not obese, 30-<35, ≥35) there was no difference in 30 day postoperative morbidity and mortality. When the interaction of obesity with the biology of the underlying primary was studied there was no obesity related survival differences. For obese and non-obese patients, median survival for low grade appendiceal cancer was 76 months and 107 months respectively (p=0.38) and for colon cancer was 18.1 months and 19.8 months. 5 and 10 year survival for the low grade appendiceal group was 60.5% and 33.1% for obese and 69.1% and 46.5% for non obese (p=0.38). Conclusions: Obesity does not influence postoperative morbidity and mortality of patients with peritoneal surface disease (PSD) regardless of primary. Obesity does not influence long term survival for appendiceal and colon cancer patients with PSD, and should not be considered a contraindication for the procedure.

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