scholarly journals IMMEDIATE AND REMOTE RESULTS OF PALLIATIVE SURGERY IN PATIENTS WITH METASTATIC COLORECTAL CANCER

2017 ◽  
Vol 22 (1) ◽  
pp. 32-38
Author(s):  
E. P Kulikov ◽  
M. E Ryazantsev ◽  
N. I Verkin ◽  
E. Yu Golovkin ◽  
M. A Porvatova ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Mortality Rate ◽  
Metastatic Colorectal Cancer ◽  
Median Survival ◽  
Postoperative Mortality ◽  
Colon Resection ◽  
High Rate ◽  
Morbidity Rate ◽  
One Year

The significance of the study is associated with the high level of the morbidity rate of colorectal cancer, generous amount of patients with the 4th stage and the necessity of the research of palliative surgical treatment. A retrospective analysis of 364 cases with metastatic colorectal cancer included 58 patients with palliative colon resection and 306 patients with bypass anastomosis and unloading stoma. Evaluated parameters are the frequency of postoperative complications, postoperative mortality rate, median survival and one-year survival. In the group of palliative resections the frequency of postoperative complications and postoperative mortality rate were 32.7% and 20.6%, in the group of symptomatic operations the same results were 12.1% and 8.8%. Median survival, one-year survival in the group of palliative resections are longer than in the group of symptomatic operations - 10.0 and 5.1 months, 37.0% and 18.3%, respectively (p < 0.05). However, after stratification of studied subgroups according to the sign of the presence or absence of post-operative chemotherapy the survival were shown to be higher in patients with chemotherapy and hardly depended on fact of the removal of the primary tumor. To our opinion the high rate of postoperative complications and the postoperative mortality rate after palliative resections of the colon can be corrected by more precise determination of indications to their performance in emergency surgery. The improvement in survival indices is associated with the execution of postoperative adjuvant chemotherapy.

Low preoperative platelets to predict postoperative liver dysfunction in patients with metastatic colorectal cancer undergoing liver resection.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 634-634
Author(s):  
Patrick Starlinger ◽  
Beata Herberger ◽  
Dietmar Tamandl ◽  
Stefan Stremitzer ◽  
Christine Brostjan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
High Risk ◽  
Postoperative Complications ◽  
Metastatic Colorectal Cancer ◽  
Liver Dysfunction ◽  
Postoperative Mortality ◽  
Platelet Counts ◽  
The Impact ◽  
Selection Of

634 Background: Despite improving median survival of metastatic colorectal cancer (mCRC) patients, chemotherapy (CTx) compromises liver function. Therefore, selection of patients who are of high risk to develop liver dysfunction (LD) after surgery is important. As platelets are of major importance in liver regeneration, we investigated the impact of preoperative platelet counts on the incidence of postoperative LD and its correlation to postoperative morbidity and mortality. Methods: Patients treated with liver resection for mCRC between January 2000 and December 2010 were eligible. LD was defined as bilirubin > 5 mg/dL or prothrombin time <50% within the first postoperative week. The association of preoperative platelets < 150 x 103/ml with LD, 90 days mortality and surgical complications was analyzed. Results: 518 patients with metastatic CRC cancer underwent liver resection, of whom 68% had received neoadjuvant CTx. 21% of all patients developed LD. Postoperative complications occurred in 13.5%. 10 patients died within 90 days after liver resection (1.9%). The incidence of LD and complications was significantly higher in patients with preoperative platelets < 150 x 103/ml (P=0.010, P=0.047). 90 days mortality was nearly 3 times higher in patients with reduced preoperative platelets (9.8% vs. 3.7%). Neoadjuvant CTx was associated with an increased rate of platelets < 150 x 103/ml (with CTx 25%, without CTx 17%; P=0.051), LD (with CTx 23%, without CTx 15%; P=0.029) and postoperative mortality (with CTx 5.3%, without CTx 2.5%). Conclusions: Patients with platelets < 150 x 103/ml have an increased incidence of postoperative LD, major complications and 90 days mortality. Using this simple routine parameter, it might be possible to select patients that could be better served with alternative treatments such as radiofrequency ablation. Furthermore, reduced platelet counts and the incidence of LD were more frequent in patients after neoadjuvant CTx resulting in an increased 90 days mortality. This suggests that patients after extensive CTx accompanied by low platelets are of high risk to suffer from postoperative complications and surgical treatment should be reconsidered.

Impact of irinotecan and oxaliplatin on overall survival in patients with metastatic colorectal cancer (MCRC): A population- based study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4077-4077 ◽  
Author(s):  
H. J. Lim ◽  
C. Fitzgerald ◽  
S. Gill ◽  
B. Melosky ◽  
C. Speers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Median Survival ◽  
Population Based ◽  
Population Based Study ◽  
Chemotherapy Agent ◽  
Kaplan Meier ◽  
Cancer Agency ◽  
One Year

4077 Background: Over the past 10 years, chemotherapeutic options for MCRC has significantly expanded from 5-FU based therapy, to include irinotecan and oxaliplatin. The effect of the availability of these treatments on overall survival is evaluated among patients in 3 time cohorts referred to the British Columbia Cancer Agency (BCCA). Methods: Patients with newly diagnosed or relapsed metastatic colorectal cancer referred to the BCCA in 1995/96, 2000 and 2003/04 were included. In 1995/96, 5-FU was the only palliative chemotherapy agent available at BCCA and irinotecan and oxaliplatin were available in 2000 and 2003, respectively. A one year period was used for the irinotecan cohort to minimize overlap between groups. Overall survival estimates were generated using the Kaplan Meier method. Survival was calculated from time of diagnosis of distant metastatic disease to either death or last contact date. Results: Cohorts were generally similar, however, a significantly higher proportion of patients received chemotherapy in more recent eras ( Table 1 ). Only 25% of patients received both irinotecan and oxaliplatin in 2003/4 and only 10 % received biologic therapies. An improvement in median survival of 3.6 months was observed. The improvement in the treated subgroup was 4.2 months. Outcomes of patients untreated with chemotherapy were unchanged between cohorts. Conclusions: In this population based study, the proportion of patients with MCRC treated with chemotherapy significantly increased between 1995/6 and 2000/2003/4. Patients treated with chemotherapy experienced a 4.2 month increase in median survival in 2003/4 compared to 1995/6. Survival improvements were only significant in the time period when all three effective chemotherapies (5FU, irinotecan and oxaliplatin) were available. As bevacizumab was not available until 2006, its survival impact in this population is not yet known. [Table: see text] No significant financial relationships to disclose.

Outcome of use of regorafenib in metastatic colorectal cancer in routine clinic practice in Saudi Arabia.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15021-e15021
Author(s):  
Ali Husain Aljubran ◽  
Muhammad Zahir ◽  
Ahmed Gad ◽  
Abdelmuniem Al-Dalee ◽  
Shouki Bazarbashi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Median Survival ◽  
Kinase Inhibitor ◽  
Performance Status ◽  
Molecular Data ◽  
High Rate ◽  
Ecog Performance Status ◽  
Clinic Practice

e15021 Background: Regorafenib is a multi-kinase inhibitor that was FDA approved for the treatment of refractory advanced colorectal cancer. It has been found in the clinical trials to have modest benefit and relatively high toxicity, but the outcome of its routine use in the clinic practice is lacking. Our aim is to assess the outcome in our local clinic practice. Methods: Records of all colorectal cases who were treated with regorafenib were reviewed. Structured CRF was developed. Clinical, pathological and molecular data were collected. Efficacy and toxicity details were analyzed. Results: Thirty-two cases of metastatic colorectal cancer were treated with regorafenib from February 2014 to February 2016. All patients received prior oxaliplatin, irinotecan and bevacizumab based regimens, and cetuximab if wild type. Median age: 53.5 years. Male: 15 (46.9%). Primary tumor was right sided in 10 patients (31.3%), and left sided (including rectum) in 22 (68.7%). Pan RAS mutant: 21 (65.6%). Fifteen patients (46.9 %) had ECOG Performance Status of one, whereas 16 patients (50%) have ECOG 2. Starting dose was reduced to 120mg in 11 (34.4%). Only 5 (15.6%) continued beyond 3 cycles. 18 patients (56.3%) required dose reduction. Overall response: PR/CR: zero; Stable disease: 4 (12.5%); Progressive disease: 25 (78.1%); Clinical progression in 1 (3.1%), and 2 cases were not evaluated. After median follow up of 7 months, 22 patients (68.8%) have died, 5 (15.6%) are still alive and 5 (15.6%) are lost to follow up. Median survival: 9.3 months, and median PFS: 2.5 months. Conclusions: Regorafenib has poor tumor response in the routine clinic practice when given to patients with ECOG PS > 1. The median survival in this series is probably overestimated because of the relatively high rate of loss to follow up. Selection of patients is required in the routine clinic practice. Predictive markers are more important for such treatment with modest benefit, and significant toxicity and cost.

Pylorus-Preserving Pancreaticoduodenectomy: Evaluation of 50 Cases

2017 ◽  
Vol 13 (1) ◽  
pp. 42-45
Author(s):  
SM Shakhwat Hossain ◽  
Ferdous Rahman
Keyword(s):  
Gastric Emptying ◽  
Mortality Rate ◽  
Wound Infection ◽  
Postoperative Mortality ◽  
Operation Time ◽  
Armed Forces ◽  
Military Hospital ◽  
Morbidity Rate ◽  
Proper Patient Selection ◽  
Periampullary Neoplasms

Introduction: Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up. Objective: To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome. Materials and Methods: A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study. Results: Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%). Conclusion: The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

scholarly journals Perioperative complications of esophagectomy - prevention, diagnosis and management

2017 ◽  
Vol 64 (1) ◽  
pp. 27-38
Author(s):  
Dejan Stojakov ◽  
Predrag Sabljak ◽  
Bratislav Spica ◽  
Dejan Velickovic ◽  
Vladimir Sljukic ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Perioperative Complications ◽  
Rapid Development ◽  
Postoperative Mortality ◽  
High Volume ◽  
Esophageal Resection ◽  
Vocal Cord Palsy ◽  
Pulmonary Complications ◽  
High Rate ◽  
Septic Complications

Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset of arrhythmia could be associate with other surgical complications. Postesophagectomy chylothorax is life-threatening complication due to rapid development of immunosuppression and septic complications, and early ligation of thoracic duct is often mandatory. Intrathoracic herniation of intrabdominal viscera is rare, and ischemic spinal cord lesions are very rare after esophagectomy. Majority of perioperative complications could be prevented or solved, decreasing mortality rate of esophagectomy.

scholarly journals Association between Nutritional Status and Mortality after Aortic Valve Replacement Procedure in Elderly with Severe Aortic Stenosis

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 446 ◽  
Author(s):  
Edyta Wernio ◽  
Sylwia Małgorzewicz ◽  
Jolanta Anna Dardzińska ◽  
Dariusz Jagielak ◽  
Jan Rogowski ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Nutritional Status ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
Aortic Valve Area ◽  
One Year

Background: There is still a lack of data on the nutritional status of older people with aortic stenosis (AS) and the effect of poor nutrition on the occurrence of complications and mortality after an aortic valve replacement (AVR) procedure. The aim of this study was to assess the impact of selected nutritional status parameters in elderly patients with severe AS on the occurrence of postoperative complications and one-year mortality after the AVR procedure. Methods: 101 elderly patients with AS aged 74.6 ± 5.2 years who qualified for surgical treatment (aortic valve area [AVA] 0.73 ± 0.2 cm2) were enrolled in the study. A nutritional status assessment was performed before AVR surgery, and the frequency of postoperative complications occurring within 30 days of surgery was assessed. The one-year mortality rate was also captured. Results: Adverse events (both major and minor) up to 30 days occurred in 49.5% (n = 50) of the study population. Low Mini Nutritional Assessment (f-MNA) and Subjective Global Assessment (7-SGA) scores and low concentrations of total cholesterol, LDL-cholesterol, and prealbumin were associated with a higher risk of postoperative complications. The risk of complications increased 1.22 times (95% CI; 1.030–1.453; p = 0.019) with an impaired nutritional status. The annual mortality rate in the study group was 7.9%. Unintentional weight loss of >2.8% in the six months preceding surgery proved useful for predicting death within the first year after AVR surgery. Conclusions: The results indicate that poor nutritional status is an important factor affecting the adverse outcomes in elderly patients with severe aortic valve stenosis undergoing an AVR procedure.

Cetuximab with irinotecan or oxaliplatin for first-line metastatic colorectal cancer: Effectiveness in the EREBUS cohort compared to pivotal trials.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14542-e14542
Author(s):  
Annie Fourrier-Réglat ◽  
Magali Rouyer ◽  
Pernelle Noize ◽  
Emmanuelle Bignon ◽  
Alise Le Monies ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Treatment Initiation ◽  
Response Rate ◽  
Real Life ◽  
Wild Type ◽  
First Line ◽  
Multicenter Cohort Study ◽  
Baseline Characteristics ◽  
One Year

e14542 Background: Cetuximab (CTX) has demonstrated improved survival outcomes in metastatic colorectal cancer (mCRC) but information from real-life use is sparse. Here, CTX survival and safety outcomes in real-life are compared to those observed in OPUS and CRYSTAL trials. Methods: EREBUS is a French multicenter cohort study that included over two years (2009-2010) patients with unresectable mCRC and wild-type KRAS initiating CTX as 1st-line therapy in 65 centres and followed for 12 months from treatment initiation. Results: We included 389 patients treated with a combination of CTX with irinotecan-based (56.0%) or CTX with oxaliplatin-based (37.8%) chemotherapy. The main characteristics, safety, response rate, and one year survival of this cohort are presented in the Table below in parallel with results obtained in pivotal trials. Conclusions: Despite differences in baseline characteristics between real-life and pivotal trials (such as ECOG status), the response rate and PFS were comparable in mCRC patients with wt KRAS treated with 1st-line CTX. The nature of adverse events was in-line with the trials but the frequency was lower probably owing to under-notification in real-life. [Table: see text]

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