Insufficient Post-operative Energy Intake Is Associated With Failure of Enhanced Recovery Programs After Laparoscopic Colorectal Cancer Surgery: A Prospective Cohort Study

Background: Although enhanced recovery after surgery (ERAS) has been proven to be beneficial after laparoscopic colorectal surgery, some of the patients may fail to complete the ERAS program during hospitalization. This prospective study aims to evaluate the risk factors associated with ERAS failure after laparoscopic colorectal cancer surgery.Methods: This is a prospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included in this study. Demographic and clinicopathological characteristics were collected. Post-operative activity time and 6-min walking distance (6MWD) were measured. Patients were divided into ERAS failure group and ERAS success according to decreased post-operative activity and 6MWD. Factors associated with ERAS failure were investigated by univariate and multivariate analysis.Results: A total of 91 patients with colorectal cancer were included. The incidence of ERAS failure is 28.6% among all patients. Patients in ERAS failure group experienced higher rate of post-operative ileus and prolonged hospital stay (p < 0.001). Multivariate analysis revealed that older age (p = 0.006), body mass index ≥25.5 kg/m2 (p = 0.037), smoking (p = 0.002), operative time (p = 0.048), and post-operative energy intake <18.5 kcal/kg•d (p = 0.045) were independent risk factors of ERAS failure after laparoscopic colorectal surgery.Conclusions: Our findings indicated that a proportion of patients may fail the ERAS program after laparoscopic colorectal surgery. We for the first time showed that post-operative energy intake was an independent risk factor for ERAS failure. This may provide evidence for further investigation on precise measurement of nutritional status and selected high-risk patients for enhanced nutrition support.

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Persistent Descending Mesocolon as a Risk Factor of Laparoscopic Surgery for Colorectal Cancer: A Single Institution Experience

International Surgery ◽

10.9738/intsurg-d-16-00085.1 ◽

2019 ◽

Vol 104 (9-10) ◽

pp. 439-445

Author(s):

Hidekazu Takahashi ◽

Nobuo Tanaka ◽

Osamu Takayama ◽

Masashi Baba ◽

Masaru Murata ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Three Dimensional ◽

Tumor Location ◽

Computed Tomographic ◽

Preoperative Diagnostic ◽

Tomographic Slice

The objectives of this study are to clarify the significance of persistent descending mesocolon (PDM), a kind of intestinal malrotation, in laparoscopic colorectal surgery and present potentially useful preoperative diagnostic methods for PDM. Although several risk factors for laparoscopic colorectal surgery have been convincingly reported, the impact of PDM on laparoscopic surgery for colorectal cancer remains less studied. This was an observational study with a retrospective analysis. A consecutive 110 patients undergoing laparoscopic colorectal surgery for colorectal cancer were included. To identify risk factors for operative time of laparoscopic surgery for colorectal cancer, we examined age, sex, body mass index, American Society of Anesthesiologists Performance Status score, tumor location, depth of tumor invasion, lymph node metastasis, and PDM as potential risk factors. For identification of appropriate preoperative diagnostic imaging, we reviewed three-dimensional vessel images reconstructed from computed tomographic slice data of all patients. During the study period, no effective pre- or intraoperative diagnoses of PDM were achieved. A total of 4 patients were diagnosed with PDM. Sex (P = 0.0032); tumor location (P = 0.0044); lymph node metastasis (P = 0.022); and PDM (P = 0.0007) were identified as risk factors based on multivariate analysis. A ventrally branched left colic artery visualized by three-dimensional imaging appeared to be a highly specific feature of PDM. Laparoscopic surgery for colorectal cancer with PDM was difficult without the recognition of PDM. PDM was well-defined preoperatively using three-dimensional vessels images reconstructed from computed tomographic slice data.

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Causes and management of bleeding during laparoscopic colorectal cancer surgery

Reports in Clinical Studies and Medicine ◽

10.18282/cs.v1.i1.26 ◽

2018 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Ming Xu ◽

Weiqiang Wu ◽

Zengqiang Yang ◽

Feng Gao

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Anatomic Variation ◽

Anatomical Structure ◽

Cancer Surgery ◽

Cognitive Level ◽

Colorectal Cancer Surgery

<p class="Abstract">In this paper, the causes of bleeding during laparoscopic colorectal surgery and the measures to solve it are discussed. 386 cases of laparoscopic colorectal cancer surgery in our hospital from January to December 2015 were selected. There were 17 cases of bleeding during surgery, which accounted for 4.4% of the total amount. 2 cases were converted to laparotomy, and 15 cases were surgery via laparoscopy. In the surgical process, improper surgery, lack of good laparoscopic anatomical structure of the cognitive level, and congenital anatomic variation may have caused the accidental bleeding during surgery. Corresponding measures should be taken to stop accidental bleeding. </p>

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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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Causes and management of bleeding during laparoscopic colorectal cancer surgery

Reports in Clinical Studies and Medicine ◽

10.18282/rcsm.v1.i1.26 ◽

2018 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Ming Xu ◽

Weiqiang Wu ◽

Zengqiang Yang ◽

Feng Gao

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Anatomic Variation ◽

Anatomical Structure ◽

Cancer Surgery ◽

Cognitive Level ◽

Colorectal Cancer Surgery

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Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2009.25.3.165 ◽

2009 ◽

Vol 25 (3) ◽

pp. 165 ◽

Cited By ~ 4

Author(s):

Dong Baek Kang ◽

Chang Yeol Shin ◽

Jeong Kyun Lee ◽

Won Cheol Park

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multivariate Analysis ◽

Emergency Operation ◽

Factors Associated ◽

Perforated Colorectal Cancer ◽

Complications And Mortality

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Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03984-w ◽

2021 ◽

Author(s):

Petrus Boström ◽

Johan Svensson ◽

Camilla Brorsson ◽

Martin Rutegård

Keyword(s):

Colorectal Cancer ◽

Postoperative Pain ◽

Colorectal Surgery ◽

Anastomotic Leakage ◽

Rating Scale ◽

Numerical Rating Scale ◽

Population Based ◽

Colorectal Cancer Surgery ◽

Increased Risk ◽

Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

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A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis

Cancers ◽

10.3390/cancers13092025 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2025

Author(s):

Tomasz Sawicki ◽

Monika Ruszkowska ◽

Anna Danielewicz ◽

Ewa Niedźwiedzka ◽

Tomasz Arłukowicz ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Physical Inactivity ◽

Ecological Factors ◽

Population Based ◽

Review Article ◽

Therapeutic Interventions ◽

Factors Associated ◽

Hereditary Factors ◽

Disease Stages

This review article contains a concise consideration of genetic and environmental risk factors for colorectal cancer. Known risk factors associated with colorectal cancer include familial and hereditary factors and lifestyle-related and ecological factors. Lifestyle factors are significant because of the potential for improving our understanding of the disease. Physical inactivity, obesity, smoking and alcohol consumption can also be addressed through therapeutic interventions. We also made efforts to systematize available literature and data on epidemiology, diagnosis, type and nature of symptoms and disease stages. Further study of colorectal cancer and progress made globally is crucial to inform future strategies in controlling the disease’s burden through population-based preventative initiatives.

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