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

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.

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Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery?

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2010.06.001 ◽

2010 ◽

Vol 1 (2) ◽

pp. 57-65 ◽

Cited By ~ 49

Author(s):

Siri R. Kristjansson ◽

Marit S. Jordhøy ◽

Arild Nesbakken ◽

Eva Skovlund ◽

Arne Bakka ◽

...

Keyword(s):

Colorectal Cancer ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Early Mortality ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Operative Complications ◽

Post Operative Complications

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Is Laparoscopic Colorectal Cancer Surgery in Obese Patients Associated with an Increased Risk? Short-Term Results from a Single Center Study of 425 Patients

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-012-1928-0 ◽

2012 ◽

Vol 16 (8) ◽

pp. 1554-1558 ◽

Cited By ~ 29

Author(s):

Martin Poulsen ◽

Henrik Ovesen

Keyword(s):

Colorectal Cancer ◽

Cancer Surgery ◽

Obese Patients ◽

Single Center ◽

Short Term ◽

Colorectal Cancer Surgery ◽

Increased Risk ◽

Single Center Study ◽

Center Study

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Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

Medicina ◽

10.3390/medicina57050472 ◽

2021 ◽

Vol 57 (5) ◽

pp. 472

Author(s):

Zalán Benedek ◽

Szabolcs Todor-Boér ◽

Loránd Kocsis ◽

Orsolya Bauer ◽

Nicolae Suciu ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Psoas Muscle ◽

Albumin Level ◽

Cancer Surgery ◽

High Grade ◽

C Reactive Protein ◽

Muscle Area ◽

Colorectal Cancer Surgery ◽

Reactive Protein

Background and Objectives: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia measured by psoas muscle index on computer tomography scans and the presence of postoperative complications in colorectal cancer surgery. Materials and Methods: In a prospective study we recorded data from 51 patients who underwent colorectal cancer surgery in the Mures County Clinical Hospital, Romania. Total psoas muscle area and psoas density were measured at the level of the third lumbal vertebra (L3) for further index calculation. We also evaluated the general characteristics and laboratory analyses to obtain more information about status of the patients. Short-term postoperative complications were scored according to the Clavien-Dindo classification. Results: The majority of the 51 patients were male (61%) and the median age was 65 years. More than half of the cancer was located in the rectum (56.9%), a quarter in the right colon (25.5%), the rest in the sigmoid (11.8%), and the left colon (5.9%). Twenty-one patients (41.2%) developed a complication, five (9.8%) of these were Clavien-Dindo grade 3, 4 or 5 (high grade) and sixteen (31.3%) grade 1 or 2 (low grade). The low- and high-grade groups showed a significantly lower right psoas muscle area, left psoas muscle area, total psoas muscle area, and psoas muscle index (p < 0.001 in all cases). Among laboratory analyses, a significantly lower perioperative hematocrit, hemoglobin, and albumin level were found in patients who developed complications. Furthermore we observed that an elevated serum C-reactive protein level was associated with a higher grade of complication (p < 0.043). Conclusions: The psoas muscle index (PMI) influence on the postoperative outcome is an important factor in our single center prospective study and it appears to be a good overall predictor in colorectal surgery. A lower PMI is directly associated with a low or high grade complication by Clavien-Dindo classification. Perioperative inflammatory and nutritional status evidenced by serum C-reactive protein (CRP) and albumin level influences the presence of postoperative complications.

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

10.21203/rs.3.rs-58037/v1 ◽

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

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

Journal of Colon and Rectal Cancer ◽

10.14302/issn.2471-7061.jcrc-18-2446 ◽

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.

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Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2021/9204373 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Yu Yang ◽

Yuxuan Li ◽

Xiaohui Du

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Anastomotic Leakage ◽

Incidence Rate ◽

Intraperitoneal Chemotherapy ◽

Meta Analysis ◽

Abdominal Cavity ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Increased Risk

Purpose. To identify and evaluate the influence of intraperitoneal chemotherapy without hyperthermia (ICwh) to the incidence of anastomotic leakage (AL) after colorectal cancer surgery. Methods. A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses in order to review all studies investigating the relationship between ICwh and AL in patients undergoing colorectal surgery. The primary outcome was overall incidence rate of anastomotic leakage. Results. Four studies were included in the final review. ICwh was associated with an overall increased risk of anastomotic leakage [OR 2.05 (1.06, 3.98), P = 0.03 ]. But there was no significant increased incidence rate when fluorouracil was implanted into the abdominal cavity for ICwh [OR 2.48 (0.55, 11.10), P = 0.24 ]. Conclusions. This meta-analysis provides some evidence to suggest ICwh may increase the incidence of postoperative AL in colorectal cancer. However, fluorouracil implantation for ICwh does not increase the risk of AL, which seems to be a relatively safe method of ICwh.

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Morbidity and mortality after colorectal cancer surgery in patients with cirrhosis: A critical review of the literature.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.608 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 608-608

Author(s):

Tarek Boussaha ◽

Jean François Cadranel ◽

Allaoua Smail ◽

Hortensia Lison ◽

Armand Garioud ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Colorectal Surgery ◽

Postoperative Morbidity ◽

Cancer Surgery ◽

Morbidity And Mortality ◽

Colorectal Cancer Surgery ◽

Increased Risk ◽

Cirrhotic Patients ◽

Independent Risk Factors

608 Background: Cirrhotic patients with localized colorectal cancer are potential candidates for tumor resection. The aim of this review was to evaluate the morbi-mortality after colorectal surgery. Methods: Comprehensive search was conducted using PUBMED, EMBASE, and the COCHRANE Library. Prospective and retrospective studies were selected. The study population included cirrhotic patients who underwent colorectal resection for non-metastatic colorectal cancer and patients with benign and other malignant disease. The postoperative morbi-mortality and independent risk factors were analysed. Results: Eight studies were identified. Among these, four studies compared the risk of colorectal surgery in patients with and without liver cirrhosis. The number of patients varied from 41 to 6,120. The severity of cirrhosis in most of the studies was classified with the Child-Pugh score. Class B and C were observed in 20% to 60% of the patients. Sepsis represented the main postoperative complication and occurred in 48% to 77% of patients. Mortality varied according to the Child-Pugh score, ranging from 11% to 41%, and was significantly higher for patients with cirrhosis in Child-Pugh Class C. Urgent surgical procedure had a negative impact on prognosis. The average length of hospital stay ranged from 9 to 18 days. Cirrhosis was associated with a 2-3 time and a 4-10 time increased risk of postoperative mortality in the absence and presence of portal hypertension, respectively compared with non-cirrhotic patients. The independent risk factors for postoperative morbidity and mortality were encephalopathy, ascites, low haemoglobin, prolonged prothrombin time, elevated bilirubin, hypoalbuminemia, postoperative infection, total colectomy, elective or non-elective surgery, the presence of co-morbidities and MELD score ≥ 15. Conclusions: Colorectal cancer surgery is associated with an increased risk of postoperative morbidity and mortality in cirrhosis patients. Studies evaluating exclusively the operative risk for colorectal cancer surgery in this patient’s population are rare. Prospective controlled trials to optimize the perioperative management of those patients are needed.

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British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Gut ◽

10.1136/gutjnl-2019-319858 ◽

2019 ◽

Vol 69 (2) ◽

pp. 201-223 ◽

Cited By ~ 22

Author(s):

Matthew D Rutter ◽

James East ◽

Colin J Rees ◽

Neil Cripps ◽

James Docherty ◽

...

Keyword(s):

Colorectal Cancer ◽

Colorectal Polyp ◽

High Grade Dysplasia ◽

British Society ◽

List Type ◽

High Grade ◽

Surveillance Colonoscopy ◽

Cancer Resection ◽

Serrated Polyp ◽

Colorectal Cancer Resection

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped?two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG’s guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThis cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.

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Impact of anaemia at discharge following colorectal cancer surgery

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03611-0 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1769-1776

Author(s):

Rebecca C. Dru ◽

Nathan J. Curtis ◽

Emma L. Court ◽

Catherine Spencer ◽

Sara El Falaha ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Cancer Surgery ◽

Curative Intent ◽

Colorectal Cancer Surgery ◽

Colorectal Cancer Resection ◽

Long Term Impact ◽

L 14

Abstract Objectives Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. Methods A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. Results A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0–200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5–11] vs. 6 [5–8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04–2.5), p = 0.034). Conclusion Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.

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