Deprivation and Colorectal Cancer Surgery: Longer-Term Survival Inequalities are Due to Differential Postoperative Mortality Between Socioeconomic Groups

TÓM TẮT Đặt vấn đề: Gây tê ngoài màng cứng để giảm đau trong và sau mổ được áp dụng rộng rãi trên thế giới từ nhiều thập niên qua. Kết quả của nhiều công trình nghiên cứu cho thấy phương pháp này làm giảm những biến chứng trong và sau mổ, giảm tỉ lệ tử vong sau mổ của các phẫu thuật nặng. Nghiên cứu nhằm đánh giá hiệu quả và các tác dụng phụ của gây tê ngoài màng cứng trong phẫu thuật ung thư đại, trực tràng. Phương pháp: Nghiên cứu mô tả cắt ngang trên 28 bệnh nhân được gây tê ngoài màng cứng trong mổ ung thư đại, trực tràng có phối hợp gây mê nội khí quản. Sinh hiệu và tình trạng sức khỏe của bệnh nhân được theo dõi trước và sau khi tiêm thuốc giảm đau. Ghi nhận mức độ giảm đau theo Visual Analog Scale (VAS), mức độ liệt vận động theo Bromage và các tác dụng phụ sau mổ. Kết quả: Hiệu quả giảm đau sau mổ tốt, tại các thời điểm sau mổ VAS đều ≤ 1,5. Tỉ lệ các biến chứng: tụt huyết áp: 7,14%, đau đầu: 7,14%, lạnh run: 10,71%, buồn nôn, nôn: 17,86%. Kết luận: Kỹ thuật gây tê ngoài màng cứng phối hợp với gây mê toàn thân là kỹ thuật giảm đau hiệu quả và an toàn cho phẫu thuật vùng bụng trong mổ và 24 giờ sau mổ. ABSTRACT THE EFFICIENCY OF SPINAL EPIDURAL ANESTHESIA FOR LAPAROSCOPIC COLORECTAL CANCER SURGERY Background: Epidural anesthesia for pain relief during and after surgery has been widely applied in the world for decades. The results of many studies show that this method reduces intra - and postoperative complications and reduces the postoperative mortality rate of major surgery. The study aimed to evaluate epidural anesthesia’s effectiveness and side effects in colorectal cancer surgery. Methods: A cross - sectional descriptive study on 28 patients receiving epidural anesthesia in surgery for colorectal cancer in combination with endotracheal anesthesia. The patient’s vital signs and health status were monitored before and after the injection of pain medication. Record the level of pain relief according to the Visual Analog Scale (VAS), the degree of motor paralysis according to Bromage, and the side effects after surgery. Results: Good postoperative pain relief effect, at all times after surgery, VAS was ≤ 1.5. Rate of complications: hypotension: 7.14%, headache: 7.14%, shiver: 10.71%, nausea, vomiting: 17.86%. Conclusion: The epidural anesthesia combined with general anesthesia is an effective and safe analgesia technique for abdominal surgery during surgery and 24 hours after surgery. Keywords: Epidural anesthesia, colorectal cancersurgery

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Perioperative increase in neutrophil CD64 expression is an indicator for intra-abdominal infection after colorectal cancer surgery

Radiology and Oncology ◽

10.1515/raon-2016-0016 ◽

2017 ◽

Vol 51 (2) ◽

pp. 211-220 ◽

Cited By ~ 3

Author(s):

Milena Kerin Povsic ◽

Bojana Beovic ◽

Alojz Ihan

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Clinical Signs ◽

Cancer Surgery ◽

Surgical Trauma ◽

Colorectal Cancer Surgery ◽

Term Survival ◽

Abdominal Infection ◽

Duration Of Surgery ◽

Intra Abdominal Infection

Abstract Background Colorectal surgery is associated with a high incidence of postoperative infections. Early clinical signs are difficult to distinguish from the systemic inflammatory response related to surgical trauma. Timely diagnosis may significantly improve the outcome. The objective of this study was to compare a new biomarker index CD64 for neutrophils (iCD64n) with standard biomarkers, white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) and procalcitonin (PCT) for the early detection of postoperative infection. Methods The prospective study included 200 consecutive patients with elective colorectal cancer surgery. Postoperative values of biomarkers from the postoperative day (POD) 1 to POD5 were analysed by the receiver operating characteristic (ROC) analysis to predict infection. The Cox regression model and the Kaplan-Meier method were used to assess prognostic factors and survival. Results The increase of index CD64n (iCD64n) after surgery, expressed as the ratio iCD64n after/before surgery was a better predictor of infection than its absolute value. The best 30-day predictors of all infections were CRP on POD4 (AUC 0.72, 99% CI 0.61–0.83) and NLR on POD5 (AUC 0.69, 99% CI 0.57–0.80). The best 15-day predictors of organ/ space surgical site infection (SSI) were the ratio iCD64n on POD1 (AUC 0.72, 99% CI 0.58–0.86), POD3 (AUC 0.73, 99% CI 0.59–0.87) and CRP on POD3 (AUC 0.72, 99% CI 0.57–0.86), POD4 (AUC 0.79, 99% CI 0.64–0.93). In a multivariate analysis independent risk factors for infections were duration of surgery and perioperative transfusion while the infection itself was identified as a risk factor for a worse long-term survival. Conclusions The ratio iCD64n on POD1 is the best early predictor of intra-abdominal infection after colorectal cancer surgery. CRP predicts the infection with the same predictive value on POD3.

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Influence of Tumor Peroxisome Proliferator-Activated Receptor γ and δ Expression on Postoperative Mortality of Patients Undergoing Colorectal Cancer Surgery

Journal of Investigative Surgery ◽

10.1080/08941930802713084 ◽

2009 ◽

Vol 22 (2) ◽

pp. 105-111 ◽

Cited By ~ 4

Author(s):

Mitsuru Ishizuka ◽

Tokihiko Sawada ◽

Toshie Okada ◽

Hitoshi Nagata ◽

Kazutoshi Takagi ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Peroxisome Proliferator ◽

Colorectal Cancer Surgery ◽

Peroxisome Proliferator Activated Receptor

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The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery

Medicine ◽

10.1097/md.0000000000008520 ◽

2017 ◽

Vol 96 (47) ◽

pp. e8520 ◽

Cited By ~ 9

Author(s):

Dujanand Singh ◽

Jinglong Luo ◽

Xue-ting Liu ◽

Zinda Ma ◽

Hao Cheng ◽

...

Keyword(s):

Colorectal Cancer ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Term Survival ◽

Long Term Survival ◽

Low Ligation

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Thirty-day postoperative mortality after colorectal cancer surgery in England

Gut ◽

10.1136/gut.2010.232181 ◽

2011 ◽

Vol 60 (6) ◽

pp. 806-813 ◽

Cited By ~ 170

Author(s):

E. J. A. Morris ◽

E. F. Taylor ◽

J. D. Thomas ◽

P. Quirke ◽

P. J. Finan ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Colorectal Cancer Surgery

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Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery?

International Journal of Colorectal Disease ◽

10.1007/s00384-017-2935-0 ◽

2017 ◽

Vol 33 (2) ◽

pp. 231-234 ◽

Cited By ~ 6

Author(s):

N. J. Curtis ◽

M. Taylor ◽

L. Fraser ◽

E. Salib ◽

E. Noble ◽

...

Keyword(s):

Colorectal Cancer ◽

Enhanced Recovery ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Term Survival ◽

Long Term Survival

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Differences in colorectal cancer surgery outcomes in Serbia: Hospitals in organized colorectal cancer screening and other hospitals

PONS - medicinski casopis ◽

10.5937/pomc18-31181 ◽

2021 ◽

Vol 18 (1) ◽

pp. 8-13

Author(s):

Dušica Banković-Lazarević ◽

Verica Jovanović ◽

Biljana Mijović ◽

Jelena Brcanski ◽

Marina Jelić ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Target Group ◽

Colorectal Cancer Surgery ◽

Significant Difference ◽

The Right

Objective. The aim of this study was to compare mortality of patients after colorectal cancer surgery between hospitals in Serbia, which performed organized colorectal cancer screening and those which did not. Methods. The database included all patients who underwent surgery for colorectal cancer after the introduction of organized colorectal cancer screening Program in Serbia, in 2014-2015. The target group were patients 50-74 years old in the colorectal screening program, and the data was compared to the age-matched group from hospitals which did not perform the program logistic regression. Results. The was used to determine the significance of the differences in the observed variables, and the predictors of mortality after colorectal cancer surgery. Results. The 3631 patients were included in this study. The majority of them were operated due to the rectal cancer 2111 (58%), while 1062 (29.2%) were operated due to the colon cancer. Postoperative survival was significantly better in the target group in organized screening program (p<0.001; OR=0.46; 95%CI 0.33-0.62). There was a significant difference between patients who underwent surgery for colorectal cancer localized in the left colon, compared to the patients with localization in the right colon (p<0.001). The mortality after the surgery of colorectal cancer (4.7%) was followed by high comorbidity of cardiovascular diseases (24%). Conclusion. Patients included in the organized colorectal cancer screening have lower postoperative mortality than these not included. This indicates the necessity for further work on organized colorectal cancer screening, in order to reduce postoperative and overall mortality.

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