THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

Download Full-text

LAPAROSCOPY WITHIN MULTIMODAL OPTIMIZATION PROGRAMM IN PATIENTS WITH COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2017-0-2-47-51 ◽

2017 ◽

pp. 47-51

Author(s):

D. V. Zitta ◽

V. M. Subbotin

Keyword(s):

Colorectal Cancer ◽

Blood Loss ◽

Anastomotic Leakage ◽

Enhanced Recovery ◽

Operating Time ◽

Reoperation Rate ◽

Conventional Group ◽

Wound Infections ◽

Intraoperative Blood Loss ◽

Group 1

AIM to assess the efficacy of combination of laparoscopy and protocol of enhanced recovery in patients with colorectal cancer. MATERIALS AND METHODS. Between 2008-2016 466 patients were randomly allocated into 3 groups. Of them 266 of received perioperative treatment according to enhanced recovery protocol, 191 had routibne open procedure (group 2) and, 75 had laparoscopic operation (group 1). Patients underwent the following procedures: right hemicolectomy (n=53), left hemicolectomy (n=32), sigmoidectomy (n=55), abdomeno-perineal excision (n=67) and low anterior resection of rectum(n=201), other operation - 58. The following variables were analized: operating time, intraoperative blood loss, time of first flatus and defecation, morbidity (wound infections, anastomotic leakage, peritonitis, postoperative ileus, urinary disorders, thrombosis, cardiopulmonary complications). RESULTS. Groups were comparable in gender, comorbidities, body mass index, types of operations. Operating time did not differ significantly between 3 groups. Intraoperative blood loss was higher in conventional group. The time offirstflatus and defecation were better in group 1 and 2. Mortality rate was similar. Morbidity was lower in group 1 and 2 compared with conventional group: wound infections 1,3%, 3,1% vs 9%, anastomotic leakage 4%, 5,5% vs 9%, ileus 1,2 vs 5,4%, peritonitis 2,6%, 1,5% and 3,5%, bowel obstruction caused by the adhesions 0%, 6,8% vs 5,5%. Reoperation rate was 4%, 4,7% vs 5,5%, consequemntly. CONCLUSION. Combination of laparoscopic surgery withenhanced recovery program provides better results of treatment.

Download Full-text

Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1403-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yuan-Wei Zhang ◽

Xin Xiao ◽

Wen-Cheng Gao ◽

Yan Xiao ◽

Su-Li Zhang ◽

...

Keyword(s):

3D Printing ◽

Blood Loss ◽

Three Dimensional ◽

Operation Time ◽

Varus Deformity ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Cubitus Varus ◽

Guide Plate ◽

Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

Download Full-text

Benefit of lag screw placement by a single- or two-screw nailing system in elderly patients with AO/OTA 31-A2 trochanteric fractures

Journal of International Medical Research ◽

10.1177/03000605211003766 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110037

Author(s):

Fulong Zhao ◽

Lijuan Guo ◽

Xuefei Wang ◽

Yakui Zhang

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Fracture Healing ◽

Healing Time ◽

Harris Hip Score ◽

Intraoperative Blood Loss ◽

Trochanteric Fractures ◽

Surgical Time ◽

Gamma3 Nail ◽

Intertan Nail

Objective To retrospectively analyze the clinical outcomes of two intramedullary fixation devices, the INTERTAN nail and Gamma3 nail, for treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. Methods In total, 165 elderly patients underwent treatment for AO/OTA 31-A2 trochanteric fractures in our hospital from June 2017 to June 2018 (INTERTAN group, n = 79; Gamma3 group, n = 86). All patients underwent radiological and clinical investigations and were followed up for an average of 12 months. Age, sex, fracture type, surgical time, intraoperative blood loss, fracture healing time, and complications were compared between the two groups. Results The surgical time was significantly shorter and the intraoperative blood loss volume was significantly lower in the Gamma3 than INTERTAN group (58.2 ± 2.5 vs. 81.7 ± 14.2 minutes and 170 ± 29 vs. 220 ± 16 mL, respectively). However, there were no significant differences in the reduction quality, hospital stay, fracture healing time, Harris hip score, postoperative complications, or 1-year postoperative mortality. Conclusion Both INTERTAN and Gamma3 nails may be effective for surgical treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. However, the Gamma3 nail was superior to the INTERTAN nail in terms of surgical time and intraoperative blood loss.

Download Full-text

RETRACTED: Fast track for elderly patients: Is it feasible for colorectal surgery?

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.389 ◽

2014 ◽

Vol 12 ◽

pp. S20-S22 ◽

Cited By ~ 17

Author(s):

Rita Compagna ◽

Giovanni Aprea ◽

Davide De Rosa ◽

Maurizio Gentile ◽

Giovanni Cestaro ◽

...

Keyword(s):

Colorectal Surgery ◽

Elderly Patients ◽

Fast Track

Download Full-text

Risk factors for postoperative systemic complications in elderly patients with brain tumors

Journal of Neurosurgery ◽

10.3171/2008.10.17669 ◽

2009 ◽

Vol 111 (2) ◽

pp. 258-264 ◽

Cited By ~ 7

Author(s):

Kenichiro Asano ◽

Takahiro Nakano ◽

Tetsuji Takeda ◽

Hiroki Ohkuma

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Brain Tumors ◽

Blood Loss ◽

Elderly Patients ◽

Univariate Analysis ◽

Intraoperative Blood Loss ◽

Systemic Complications ◽

Level Difference ◽

Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

Download Full-text

Retraction notice to “Fast track for elderly patients: Is it feasible for colorectal surgery?” [International Journal of Surgery 12 (2014) S20 – S22]

International Journal of Surgery ◽

10.1016/j.ijsu.2017.10.032 ◽

2017 ◽

Vol 47 ◽

pp. 152 ◽

Cited By ~ 2

Author(s):

Rita Compagna ◽

Giovanni Aprea ◽

Davide De Rosa ◽

Maurizio Gentile ◽

Giovanni Cestaro ◽

...

Keyword(s):

Colorectal Surgery ◽

Elderly Patients ◽

Fast Track ◽

Retraction Notice

Download Full-text

Mechanical bowel preparation versus no preparation in elective colorectal surgery: A prospective randomized study

International Journal of Surgery Open ◽

10.1016/j.ijso.2016.02.010 ◽

2016 ◽

Vol 2 ◽

pp. 26-30 ◽

Cited By ~ 4

Author(s):

Altaf Hussain Bhat ◽

Fazl Qadir Parray ◽

Nisar Ahmad Chowdri ◽

Rauf Ahmad Wani ◽

Natasha Thakur ◽

...

Keyword(s):

Colorectal Surgery ◽

Bowel Preparation ◽

Randomized Study ◽

Mechanical Bowel Preparation ◽

Prospective Randomized Study ◽

Elective Colorectal Surgery

Download Full-text

EFFECT OF KETANSERIN ON INTRAOPERATIVE BLOOD LOSS DURING TOTAL HIP ARTHROPLASTY IN ELDERLY PATIENTS UNDER GENERAL ANAESTHESIA

British Journal of Anaesthesia ◽

10.1093/bja/66.4.496 ◽

1991 ◽

Vol 66 (4) ◽

pp. 496-499 ◽

Cited By ~ 2

Author(s):

R.VAN EE ◽

J.C. VAN OENE

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Elderly Patients ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Intraoperative Blood Loss ◽

Total Hip

Download Full-text

Hospital based randomized prospective study outcomes in colorectal surgery after bowel preparation

International Surgery Journal ◽

10.18203/2349-2902.isj20201395 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1191

Author(s):

Altaf Hussain Bhat ◽

Gh Hussain Mir ◽

Sajad Ahmad Bhat ◽

Muzaffar Ali

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Prospective Study ◽

Bowel Preparation ◽

Genetic Disorders ◽

Mechanical Bowel Preparation ◽

Minimal Invasive ◽

Elective Colorectal Surgery ◽

Group 2 ◽

Group 1

Background: Research of so many years from the procurable world data has shown that the reasons for most colorectal cancers occur due to change in life style the type of diet, smoking as well as the influence of the surrounding environment in which man lives and increasing age with only a minority of cases associated with genetic disorders. Colorectal cancer is the third most commonly diagnosed cancer. In the first half of the 20th century, mortality from colorectal surgery often exceeded 20%, mainly attributed to sepsis.Methods: The randomized prospective study was conducted on 202 colorectal cancer patients in the department of Colorectal division of General and Minimal Invasive surgery” Sher-i-Kashmir Institute of Medical Sciences, Srinagar.Results: Mean age of patients in Group 1 (with no mechanical bowel preparation (NMBP)) was 51±18.15 years while as same was 50±17.76 years for Group 2 (with mechanical bowel preparation (MBP)). Age range for Group 1 was 16-87 years and16-85 years for Group 2. Regarding outcomes, wound infections were 6.1% and 3.8% in Group 1 and Group 2 respectively. While disruption of anastomosis were 2.0% and 3.8% in group A and B respectively.Conclusions: Statistically no gross difference in terms of morbidity and mortality was found between the use of mechanical bowel preparation versus no use of mechanical bowel preparation in elective colorectal surgery. Elective Colorectal Surgery can safely be performed without enduring MBP in it as it does not possess any sorts of benefits.

Download Full-text

Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191784 ◽

2019 ◽

Vol 5 (3) ◽

pp. 458

Author(s):

Nikil Sanaba Paramesh ◽

Usman Taufiq

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Elderly Patients ◽

Operation Time ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Intraoperative Blood Loss ◽

Cerebrovascular Complications ◽

Uncemented Hemiarthroplasty ◽

Hip Function

Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

Download Full-text