scholarly journals NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’

2018 ◽  
Vol 100 (4) ◽  
pp. 275-278
Author(s):  
PJJ Herrod ◽  
M Cox ◽  
H Keevil ◽  
KJE Smith ◽  
JN Lund
Keyword(s):  
Colorectal Cancer ◽  
Scoring Systems ◽  
Major Surgery ◽  
International Consensus ◽  
Colorectal Cancer Surgery ◽  
Septic Complications ◽  
Coin Toss ◽  
Colorectal Cancer Resection ◽  
Infective Complications ◽  
Sirs Criteria

Background and aims Late recognition of sepsis and consequent death remains a problem. To address this, the National Institute for Health and Care Excellence has published updated guidance recommending the use of the Quick Sequential Organ Failure Assessment (Q-SOFA) score when assessing patients at risk of sepsis following the publication of the Third International Consensus Definitions for Sepsis and Septic Shock. The trauma from major surgery produces a systemic inflammatory response syndrome (SIRS) postoperatively as part of its natural history, which may falsely trigger scoring systems. We aimed to assess the accuracy of Q-SOFA and SIRS criteria as recommended scores for early detection of sepsis and septic complications in the first 48hrs after colorectal cancer surgery. Methods We reviewed all elective major colorectal operations in a single centre during a 12-month period from prospectively maintained electronic records. Results One hundred and thirty nine patients were included in this study. In all, 29 patients developed postoperative infective complications in hospital. Nineteen patients triggered on SIRS without developing infective complications, while 42 patients triggered on Q-SOFA with no infective complications. The area under the ROC curve was 0.52 for Q-SOFA and 0.67 for SIRS. Discussion Q-SOFA appears to perform little better than a coin toss at identifying postoperative sepsis after colorectal cancer resection and is inferior to the SIRS criteria. More work is required to assess whether a combination of scoring criteria, biochemical markers and automated tools could increase accurate detection of postoperative infection and trigger early intervention.

scholarly journals A prospective cohort study of older colorectal cancer surgical patients: an association of post-operative clinical outcome with sarcopenia, frailty, and nutritional status [Protocol] (Preprint)

2019 ◽  
Author(s):  
Nia Humphry
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Nutritional Status ◽  
Significant Proportion ◽  
The Elderly ◽  
Operative Risk ◽  
Surgical Patients ◽  
Clinical Frailty Scale ◽  
Colorectal Cancer Surgery ◽  
Colorectal Cancer Resection

UNSTRUCTURED Older patients account for a significant proportion of patients undergoing colorectal cancer surgery, and are vulnerable to a number of pre-operative risk factors that are not often present in younger patients. Three pre-operative risk factors more prevalent in the elderly are frailty, sarcopenia, and malnutrition. Whilst each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. One particular area of increasing interest is the use of urine metabolomics for objective evaluation of dietary profiles and malnutrition. Herein we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. These procedures include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (with hand grip strength and 4-metre walk test), muscle mass evaluations using computerized tomography morphometric analysis and evaluation of nutritional status using analysis of urinary dietary biomarkers. As these are all areas of common derangement in the elderly surgical population, prospectively studying them in concert will allow for analysis of their interplay as well as the development of predictive models for those at risk for commonly tracked surgical complications and outcomes.

Đánh giá hiệu quả giảm đau bằng gây tê ngoài màng cứng trong phẫu thuật nội soi cắt đại, trực tràng

2022 ◽  
Author(s):  
Thanh Xuan Nguyen
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Epidural Anesthesia ◽  
Postoperative Mortality ◽  
Cancer Surgery ◽  
Major Surgery ◽  
Analog Scale ◽  
Colorectal Cancer Surgery

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

scholarly journals Social Support and Physical Activity in the Perioperative Period and Six Months After Colorectal Cancer Surgery.

2020 ◽  
Author(s):  
Jarosław Ocalewski ◽  
Patrycja Michalska ◽  
Paweł Izdebski
Keyword(s):  
Physical Activity ◽  
Colorectal Cancer ◽  
Social Support ◽  
Self Efficacy ◽  
Negative Impact ◽  
Perioperative Period ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Cancer Symptoms ◽  
Colorectal Cancer Resection

Abstract Background: According to the recommendations of the ERAS protocol, physical activity is a key behavior for pre-surgical preparation of patients. The research aimed at determining the relationship between physical activity and social support, self-efficacy, cancer symptoms in preparation for colorectal cancer resection and half a year after surgery.Methods: The research was carried out among patients with colorectal cancer. The assessment was performed in a longitudinal study, a week before the surgery (T1) (N=151) and six months after the surgery (T2) (N=105). The data was collected through the following research tools: physical activity, social support (OSS-3), self-efficacy (GSES) and the experienced cancer symptoms (Brief IPQ).Results: In a week before the surgery, social support facilitated in the time of physical activity (β=.18), whereas half a year after the surgery social support had a negative impact on the time of physical activity (β=-.20). The variable of symptoms is related to the negative effect of physical activity, and this is particularly evident in the six-month period after surgery (a week before the surgery: β=-.16; six months after the surgery: β=-.34).Conclusions: It has been shown that social support, symptoms are important for shaping physical activity in the period before colorectal cancer surgery and six months after surgery. Patients with colorectal cancer living alone have had higher levels of physical activity than patients with colorectal cancer living in a partnership. In the period after colorectal cancer surgery social support may lead patients to believe that they do not need to make any physical effort because caregivers take care of their daily responsibilities.Trial registrations: Ocalewski J, Michalska P. Social support and physical activity in the preoperative period and six months after colon cancer surgery. [Internet]. OSF; 2020. Available from: osf.io/px2zk

scholarly journals P47 Evaluating the Relationship of Pre-Assessment Host Systemic Inflammatory Response Biomarkers (Neutrophil Lymphocyte Ratio) to Post-Operative Infective Complication Risk in Colorectal Cancer Resection

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Gordon Cooper ◽  
Katrina Knight ◽  
Pamela Bain ◽  
Morag McLellan ◽  
Giuliana Torpiano ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Response ◽  
Systemic Inflammatory Response ◽  
P Value ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Complication Risk ◽  
Colorectal Cancer Resection ◽  
Infective Complications

Abstract Introduction The host systemic inflammatory response (SIR) is prognostic in a wide variety of solid tumours, with a greater degree of inflammation being associated with a worse clinical outcome. Neutrophil Lymphocyte Ratio (NLR) is an established way to measure SIR in vivo. We aimed to establish whether preoperative NLR correlates with infective complications in patients undergoing colorectal cancer (CRC) resection. Methods Data was extracted retrospectively for all CRC resections over a 2 year period (2016-2018) at a single district general hospital. NLR was measured for each patient from bloods at the time of pre-operative assessment. Post-operative complications were recorded using the Clavien-Dindo classification and subsequently classified as infective and non-infective. A Two-tailed Mann-Whitney U test was used to evaluate the data from an online resource. Results Of the 131 patients, 49 had complications of which 20 were infective. Of total complications 58% were male and 35% were aged 75 years or older. Current or ex-smokers constituted 43% and 41 of the total patients had a BMI >30 kg/m2. Pre-assessment mean NLR was 2.3 in those without complications and 4.7 in those with any complication. A mean NLR of 5.4 was present in those with infective complications, p-value 0.026. Conclusion This study found that a raised NLR was present preoperatively in those who developed infective complications following CRC resection. This is a simple, readily available and cost-effective method of identifying patients at risk of complication. This ultimately may be useful in highlighting patients who would benefit from enhanced pre-operative optimisation. Further research to validate these findings in larger studies would seem warranted.

scholarly journals Preoperative and Postoperative N-terminal Pro B-type Natriuretic Peptide Levels Predict Cardiac Morbidity and Mortality in Patients Undergoing Colorectal Cancer Resection

2019 ◽  
Vol 1 (3) ◽  
pp. 1-9
Author(s):  
Haney Youssef ◽  
Enrique Collantes ◽  
James Hunter ◽  
Julie Stinson ◽  
Steve Smith ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Good Predictor ◽  
Strong Predictor ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Cardiac Complications ◽  
Operating Characteristics ◽  
Colorectal Cancer Surgery ◽  
Cardiac Morbidity ◽  
Colorectal Cancer Resection

Introduction: Cardiac complications are a major cause of perioperative morbidity and mortality in patients undergoing colorectal cancer surgery. A quick and reliable system for predicting postoperative cardiac morbidity is needed to predict cardiac events in order to improve outcome in surgery. The aim of this study was to investigate the role of the biochemical marker NT-proBNP in the prediction of postoperative all-cause mortality, cardiac-related mortality and cardiovascular events in patients undergoing colorectal cancer resections. Methods: 100 consecutive patients undergoing colorectal cancer surgery were prospectively recruited. Blood samples were taken preoperatively, 24h, 48h and 5-7 postoperative days to measure NT-proBNP levels. The predictive power of NT-proBNP levels was assessed using Receiver Operating Characteristics (ROC) curves. Results: Cardiac-related morbidity and mortality was 9%. Of eleven deaths, 5 were cardiac-related. Preoperative NT-proBNP was a good predictor of death with ROC area under curve (AUC) of 0.83 (95% C.I. 0.673, 0.993) a strong predictor of cardiac death with AUC of 0.914 (95% C.I. 0.823, 1.000) and a good predictor of cardiac complications with AUC of 0.875 (95% C.I. 0.757, 0.993). NT-proBNP levels 24 hours and 48 hours postoperatively were also strongly predictive of postoperative cardiac morbidity and mortality. Conclusion: Pre- and postoperative NT-proBNP have a role in predicting postoperative death and cardiac complications. This may have significant implications in the planning of postoperative care for high-risk patients.

scholarly journals Meta‐analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

BJS Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. 737-747
Author(s):  
J. Lawler ◽  
M. Choynowski ◽  
K. Bailey ◽  
M. Bucholc ◽  
A. Johnston ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Meta Analysis ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Oncological Outcomes ◽  
The Impact ◽  
Infective Complications

Mo1699 Infective Complications Following Colorectal Cancer Resection - Enhanced Recovery Confers No Advantage Over Conventional Care

2013 ◽  
Vol 144 (5) ◽  
pp. S-1093-S-1094
Author(s):  
Michelle L. Ramanathan ◽  
Graham MacKay ◽  
Jonathan J. Platt ◽  
Paul G. Horgan ◽  
Donald C. McMillan
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Conventional Care ◽  
Cancer Resection ◽  
Colorectal Cancer Resection ◽  
Infective Complications

scholarly journals The impact of comorbidities on post-operative complications following colorectal cancer surgery

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243995
Author(s):  
David E. Flynn ◽  
Derek Mao ◽  
Stephanie T. Yerkovich ◽  
Robert Franz ◽  
Harish Iswariah ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Atrial Fibrillation ◽  
Cancer Surgery ◽  
High Grade ◽  
Colorectal Cancer Surgery ◽  
Cancer Resection ◽  
Colorectal Cancer Resection ◽  
Increased Risk ◽  
Operative Complications ◽  
Post Operative Complications

Background Colorectal cancer surgery is complex and can result in severe post-operative complications. Optimisation of surgical outcomes requires a thorough understanding of the background complexity and comorbid status of patients. Aim The aim of this study is to determine whether certain pre-existing comorbidities are associated with high grade post-operative complications following colorectal cancer surgery. The study also aims to define the prevalence of demographic, comorbid and surgical features in a population undergoing colorectal cancer resection. Method A colorectal cancer database at The Prince Charles Hospital was established to capture detailed information on patient background, comorbidities and clinicopathological features. A single-centre retrospective study was undertaken to assess the effect of comorbidities on post-operative outcomes following colorectal cancer resection. Five hundred and thirty-three patients were reviewed between 2010–2018 to assess if specific comorbidities were associated with higher grade post-operative complications. A Clavien-Dindo grade of three or higher was defined as a high grade complication. Results Fifty-eight percent of all patients had an ASA grade of ASA III or above. The average BMI of patients undergoing resection was 28 ± 6.0. Sixteen percent of all patients experienced a high grade complications. Patients with high grade complications had a higher mean average age compared to patients with low grade or no post-operative complications (74 years vs 70 years, p = 0.01). Univariate analysis revealed patients with atrial fibrillation, COPD, ischaemic heart disease and heart failure had an increased risk of high grade complications. Multivariate analysis revealed pre-existing atrial fibrillation (OR 2.70, 95% CI 1.53–4.89, p <0.01) and COPD (OR 2.02 1.07–3.80, p = 0.029) were independently associated with an increased risk of high grade complications. Conclusion Pre-existing atrial fibrillation and COPD are independent risk factors for high grade complications. Targeted perioperative management is necessary to optimise outcomes.

scholarly journals Predictor of septic complications in colorectal cancer surgery

2018 ◽  
Vol 11 (1) ◽  
pp. 33-37
Author(s):  
Ilgiz Gabdullovitch Gataullin ◽  
Valeriy Germanovitch Savinkov ◽  
Sergey Aleksandrovitch Frolov ◽  
Alexey Mihailovitch Kozlov
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Good Prognosis ◽  
Early Postoperative Period ◽  
C Reactive Protein ◽  
Colorectal Cancer Surgery ◽  
Septic Complications ◽  
Reactive Protein ◽  
Hospital Patients ◽  
Colorectal Cancer Patients

Prediction in colorectal surgery is very useful instrument in managing the health care system in hospitals. Searching for reliable risk factors of postoperative complications allows to identify patients of a high risk of complications group and to discharge earlier from hospital patients with a good prognosis. C-reactive protein is well known as a sensitive and dynamic marker of systemic inflammatory response syndrome. This study evaluated the feasibility of using C-reactive protein as predictor of septic postoperative complications. It was shown that analysis of serum CRP in early postoperative period   allows to predict septic postoperative complications in colorectal cancer patients.

Sign in / Sign up

Export Citation Format

Share Document