scholarly journals Risk Factors for Complications following Introduction of Radical Surgery for Colon Cancer: A Consecutive Patient Series

2018 ◽  
Vol 108 (2) ◽  
pp. 144-151 ◽  
Author(s):  
B. Furnes ◽  
K. E. Storli ◽  
H. M. Forsmo ◽  
A. Karliczek ◽  
G. E. Eide ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Logistic Regression ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Open Surgery ◽  
Multinomial Logistic Regression ◽  
Operating Time ◽  
Surgical Techniques ◽  
Complete Mesocolic Excision ◽  
Mesocolic Excision

Background: Rectal cancer surgery is standardized, resulting in improved survival. Colon cancer has fallen behind and therefore more radical surgical techniques have been introduced. One technique is complete mesocolic excision. The aim of this article was to study the complications after the introduction of standardized complete mesocolic excision in a single center. Methods: Complete mesocolic excision was introduced in 2007, and data were collected from 286 patients prior to surgery (2007–2010). The surgeon decided on open or laparoscopic surgery. Follow-up information was recorded until 31 December 2015. Complications were classified according to a modified Clavien–Dindo classification. Results: Complications occurred in 47%, severe complications (grade III and IV) in 15%. In-hospital mortality was 3.5%. A total of 142 patients (49.7%) were operated by open surgery. Logistic regression revealed anemia (p = 0.001), open surgery (p < 0.001), and long operating time (p < 0.001) as significant factors for complications in general. Multinomial logistic regression revealed that severe complications occurred more often in males (odds ratio: 2.56; 95% confidence interval: 0.98–6.68), patients with anemia (odds ratio: 3.49; 95% confidence interval: 1.27–9.60), elevated body mass index (odds ratio: 1.14; 95% confidence interval: 1.02–1.28), and in open surgery (odds ratio: 9.95; 95% confidence interval: 2.58–38.35). Age was not associated with severe complications. Survival was not significantly influenced by complications. Overall survival (5 years) was 90% among patients with complications and 92% among those without complications. Conclusion: Severe complications following the introduction of complete mesocolic excision are patient dependent and related to open surgery. Patients selected for laparoscopy had less number of complications; therefore, introducing complete mesocolic excision by laparoscopy is justified. Identification of these factors can improve selection of appropriate surgical approach and postoperative patient safety.

scholarly journals Robotic Complete Mesocolic Excision with Central Vascular Ligation for Right Colon Cancer: Surgical Technique and Short-term Outcomes

2020 ◽  
Vol 11 (4) ◽  
pp. 674-683
Author(s):  
C. Ramachandra ◽  
Pavan Sugoor ◽  
Uday Karjol ◽  
Ravi Arjunan ◽  
Syed Altaf ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Open Surgery ◽  
Complete Mesocolic Excision ◽  
Right Colon ◽  
Short Term ◽  
Central Vascular Ligation ◽  
Oncological Outcomes ◽  
Right Colon Cancer ◽  
Vascular Ligation ◽  
Mesocolic Excision

Abstract Background Minimally invasive colorectal surgery has demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. Purpose The study aims to present technical details and short-term oncological outcomes of robotic-assisted complete mesocolic excision (CME) with central vascular ligation (CVL) for right colon cancer. Methodology Fifty-two consecutive patients affected by right colon cancer were operated between May 2016 and February 2020 with da Vinci Xi platform. Data regarding surgical and short-term oncological outcomes were systematically collected in a colorectal specific database for statistical analysis. Results Thirty-seven (71.15%) and 15 (28.85%) patients underwent right and extended right hemicoletomy with an extracorporeal anastomosis. Median age was 55 years. Mean operative time was 182 ± 36 min. Mean blood loss was 110 ± 90 ml. Conversion rate was 3.84% (two cases). 78.84% (41 cases) were pT3 and mean number of harvested lymph nodes was 28 ± 4. 1/52 (1.92%) had a documented anastomotic leak requiring exploratory laparotomy and diversion proximal ileostomy. Surgery-related grade IIIa–IIIb Calvien Dindo morbidity were noted in 9.61% and 1.92%, respectively. Conclusion Robotic assistance allows performance of oncological adequate dissection of the right colon with radical lymphadenectomy as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.

scholarly journals Perceived Opportunities for Physical Activity and Willingness to Be More Active in Older Adults with Different Physical Activity Levels

2021 ◽  
Vol 18 (11) ◽  
pp. 6146
Author(s):  
Eeva Aartolahti ◽  
Johanna Eronen ◽  
Timo Törmäkangas ◽  
Taina Rantanen ◽  
Mirja Hirvensalo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Logistic Regression ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Multinomial Logistic Regression ◽  
Activity Levels ◽  
Perceived Need ◽  
Community Residents ◽  
Physical Activity Levels

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, n = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% confidence interval 2.21–6.87) than not wanting to be more active compared to those perceiving good opportunities. Associations were similar at high PA levels (p < 0.001), but were not found at low PA levels. Those with moderate or high PA wish to increase their activity particularly when the perceived opportunities for activity are not optimal. Among those with low PA, perceived opportunities are not associated with a perceived need to increase physical activity. Increasing equity in physical activity in old age requires provision of support and opportunities at every level of physical activity.

scholarly journals Laparoscopic complete mesocolic excision with true central vascular ligation for right-sided colon cancer

2020 ◽  
Vol 34 (12) ◽  
pp. 5640-5641 ◽  
Author(s):  
Masanobu Enomoto ◽  
Kenji Katsumata ◽  
Kenta Kasahara ◽  
Tomoya Tago ◽  
Naoto Okazaki ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Operating Time ◽  
Complete Mesocolic Excision ◽  
Ventral Side ◽  
Central Vascular Ligation ◽  
Vascular Ligation ◽  
Mesocolic Excision ◽  
The Mean ◽  
The Right ◽  
Type V

Abstract Background Complete mesocolic excision (CME) is known to be effective for colon cancer. However, in right-sided colon cancer, central vascular ligation (CVL) is not easy to perform. In particular, in patients in whom the superior mesenteric vein (SMV) runs on the ventral side of the superior mesenteric artery (SMA) (Type V/A), laparoscopic ligation of the artery at its root is extremely difficult compared with this procedure in patients in whom the SMA runs on the ventral side of the SMV (Type A/V). Methods We started performing laparoscopic CME with true CVL for right-sided colon cancer using the SMA as a landmark in 2015, and by 2019, we had completed it for 60 patients. To start, the mesocolon is opened well to the caudal side of the ileocolic vessels. The mesentery is then fully detached from the retroperitoneal tissue, after which the ileocolic vessels are ligated at their roots. D3 lymph node dissection of the lymph nodes around the SMA and SMV on the resection side is also performed using the SMA as a landmark, and depending on the location of the tumor, the roots of the right and middle colic vessels are ligated and divided. This study was conducted with the approval of the Tokyo Medical University Ethics Committee. All patients provided informed consent. Results The tumor was located in the cecum in 21 cases, the ascending colon in 33, and the transverse colon in 6. The mean operating time was 229 min and the mean volume of hemorrhage was 67 ml. There was one Clavien-Dindo Grade 3 or worse postoperative complication (ileus). There were no surgery-related or in-hospital deaths. Conclusion This procedure can be performed comparatively safely. However, since it requires some skill, we consider that it should only be performed in suitable cases by teams with sufficient experience.

Oncological outcomes after complete mesocolic excision in right‐sided colon cancer: a population‐based study

2021 ◽  
Author(s):  
Richard Bernhoff ◽  
Annika Sjövall ◽  
Fredrik Granath ◽  
Torbjörn Holm ◽  
Anna Martling ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Complete Mesocolic Excision ◽  
Population Based ◽  
Population Based Study ◽  
Oncological Outcomes ◽  
Mesocolic Excision

scholarly journals Learning curve for single-incision laparoscopic resection of right-sided colon cancer by complete mesocolic excision

Medicine ◽  
2016 ◽  
Vol 95 (26) ◽  
pp. e3982 ◽  
Author(s):  
Chang Woo Kim ◽  
Yun Dae Han ◽  
Ha Yan Kim ◽  
Hyuk Hur ◽  
Byung Soh Min ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Learning Curve ◽  
Laparoscopic Resection ◽  
Single Incision ◽  
Complete Mesocolic Excision ◽  
Mesocolic Excision

scholarly journals Prediction of Hospital Mortality Rates by Admission Laboratory Tests

2006 ◽  
Vol 52 (2) ◽  
pp. 325-328 ◽  
Author(s):  
Paul Froom ◽  
Zvi Shimoni
Keyword(s):  
Internal Medicine ◽  
Logistic Regression ◽  
Confidence Interval ◽  
Regression Model ◽  
Odds Ratio ◽  
Laboratory Tests ◽  
Logistic Regression Model ◽  
Complete Blood Count ◽  
Laboratory Data ◽  
Regional Hospital

Abstract Background: The aim of this study was to explore whether electronically retrieved laboratory data can predict mortality in internal medicine departments in a regional hospital. Methods: All 10 308 patients hospitalized in internal medicine departments over a 1-year period were included in the cohort. Nearly all patients had a complete blood count and basic clinical chemistries on admission. We used logistic regression analysis to predict the 573 deaths (5.6%), including all variables that added significantly to the model. Results: Eight laboratory variables and age significantly and independently contributed to a logistic regression model (area under the ROC curve, 88.7%). The odds ratio for the final model per quartile of risk was 6.44 (95% confidence interval, 5.42–7.64), whereas for age alone, the odds ratio per quartile was 2.01 (95% confidence interval, 1.84–2.19). Conclusions: A logistic regression model including only age and electronically retrieved laboratory data highly predicted mortality in internal medicine departments in a regional hospital, suggesting that age and routine admission laboratory tests might be used to ensure a fair comparison when using mortality monitoring for hospital quality control.

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