Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery

(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien–Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%; 95%CI: 99.3–99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.

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Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial

BMC Cancer ◽

10.1186/s12885-019-6376-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Gilles Manceau ◽

Antoine Brouquet ◽

Pascal Chaibi ◽

Guillaume Passot ◽

Olivier Bouché ◽

...

Keyword(s):

Colon Cancer ◽

Elderly Patients ◽

Randomized Trial ◽

Postoperative Morbidity ◽

The Elderly ◽

Cancer Surgery ◽

Phase Iii ◽

Randomized Controlled ◽

Colon Cancer Surgery

Abstract Background Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population. Methods The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total. Discussion To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years. Trial registration ClinicalTrials.gov NCT03033719 (January 27, 2017).

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Comprehensive Complication Index Predicts Cancer-Specific Survival of Patients with Postoperative Complications after Curative Resection of Gastric Cancer

Gastroenterology Research and Practice ◽

10.1155/2018/4396018 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ru-Hong Tu ◽

Jian-Xian Lin ◽

Ping Li ◽

Jian-Wei Xie ◽

Jia-Bin Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Postoperative Complications ◽

Prognostic Impact ◽

Radical Gastrectomy ◽

Comprehensive Complication Index ◽

Cancer Specific Survival ◽

Independent Risk Factors ◽

The Difference ◽

Gastric Cancer Patients

Objective. To investigate the prognostic impact of postoperative complications for patients with gastric cancer. Methods. Postoperative complications of patients undergoing radical gastrectomy for gastric cancer were reviewed. The severity of complications was graded by the CCI and C-D classification. Results. A total of 5327 patients were included in the study. Complications were observed in 767 patients. When the C-D classification system was applied, for patients with grade I–II complications, the length of stay (LOS) of those with high CCI (CCI ≥ 26.2) was significantly longer than that of patients with low CCI (CCI < 26.2) (p<0.001). The 5-year cancer-specific survival rate of patients with complications (52%) was lower than that of patients without complications (61%) (p<0.001). Analysis of the factors associated with prognosis in patients with gastric cancer revealed that complications were independent risk factors for specific survival. When CCI was used to classify complication severity, the 5-year cancer-specific survival rate of the high-CCI group was 46.3%, which was lower than that of the low-CCI group (54.9%, p=0.009). Conclusion. Complication after radical gastrectomy is an independent prognostic factor, and the complication severity as graded by CCI reflects the difference of cancer-specific survival in gastric cancer patients with postoperative complications.

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Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03488-8 ◽

2019 ◽

Vol 35 (2) ◽

pp. 307-315 ◽

Cited By ~ 2

Author(s):

Susanna Niemeläinen ◽

Heini Huhtala ◽

Anu Ehrlich ◽

Jyrki Kössi ◽

Esa Jämsen ◽

...

Keyword(s):

Risk Factors ◽

Colon Cancer ◽

Postoperative Complications ◽

Population Based ◽

Cancer Surgery ◽

Mortality Data ◽

Short Term ◽

Population Based Study ◽

Colon Cancer Surgery ◽

Elective Colon

Abstract Purpose Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged. Methods All patients > 80 years operated electively for stages I–III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data. Results A total of 386 patients (mean 84.0 years, range 80–96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33–39.55, p = 0.002). Conclusions The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

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Perirenal fat surface area as a risk factor for perioperative difficulties and 30-day postoperative complications in elective colon cancer surgery

Colorectal Disease ◽

10.1111/codi.14322 ◽

2018 ◽

Vol 20 (12) ◽

pp. 1078-1087 ◽

Cited By ~ 2

Author(s):

O. der Hagopian ◽

M. Dahlberg ◽

G. Heinius ◽

J. Nordberg ◽

J. Gustafsson ◽

...

Keyword(s):

Colon Cancer ◽

Risk Factor ◽

Postoperative Complications ◽

Surface Area ◽

Cancer Surgery ◽

Colon Cancer Surgery ◽

Elective Colon ◽

Perirenal Fat

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Clinical Frailty Scale is a useful tool for predicting postoperative complications following elective colon cancer surgery in the age of 80 years and older: A prospective, multicentre observational study

Colorectal Disease ◽

10.1111/codi.15689 ◽

2021 ◽

Author(s):

Susanna Niemeläinen ◽

Heini Huhtala ◽

Jan Andersen ◽

Anu Ehrlich ◽

Eija Haukijärvi ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Observational Study ◽

Cancer Surgery ◽

Clinical Frailty Scale ◽

Colon Cancer Surgery ◽

Elective Colon

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THE MARK OF THE DURATION OF SURGERY ON THE POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH COMPLICATED COLON CANCER

Journal of Surgical Sciences ◽

10.33695/jss.v7i1.311 ◽

2020 ◽

Vol 7 (1) ◽

pp. 149-153

Author(s):

Raul Mihailov ◽

Cristina Serban ◽

Adrian Beznea ◽

Dorel Firescu ◽

Georgiana Bianca Constantin ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Statistical Significance ◽

High Rate ◽

P Value ◽

Colon Tumors ◽

Colon Cancers ◽

Duration Of Surgery ◽

Colon Cancer Surgery ◽

Anastomotic Fistula

Postoperative complications are common in patients with complicated colon cancers operated in Emergency. Most complications are those of the sound (suppurations, hematoma, dehiscence), postoperative ileus, anastomotic fistula. The purpose of this study is to evaluate the influence of the duration of the surgery on the postoperative complications in patients with complicated colon tumors, operated in emergency. We made a retrospective study on 451 patients treated for complicated colon cancers in the surgery clinics I and II of the Clinical Emergency County Hospital Galați between 2008 and 2017. In this study, we found all the 3 types of complications of colon tumors, but the most common was the intestinal obstruction. The operations varied from colostomies to subtotal and total colectomies. Most complications occured on the postoperatory days 4-8. The statistical analysis that we made revealed important statistical significance in the correlation of the postoperative complications and the duration of the surgical intervention (p value less than 0,001).The emergency colon cancer surgery has a high rate of postoperative complications, of which the most common are cardio-respiratory, parietal and fistulous. Their occurrence is directly influenced by the duration of the surgery.

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Effect of hemodialysis on short-term outcomes after colon cancer surgery

PLoS ONE ◽

10.1371/journal.pone.0262531 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262531

Author(s):

Toshio Shiraishi ◽

Tetsuro Tominaga ◽

Takashi Nonaka ◽

Shintaro Hashimoto ◽

Kiyoaki Hamada ◽

...

Keyword(s):

Colon Cancer ◽

Minimally Invasive Surgery ◽

Postoperative Complications ◽

Minimally Invasive ◽

Invasive Surgery ◽

Hemodialysis Patients ◽

Cancer Surgery ◽

Poor Performance Status ◽

Short Term ◽

Colon Cancer Surgery

Background Hemodialysis patients who undergo surgery have a high risk of postoperative complications. The aim of this study was to determine whether colon cancer surgery can be safely performed in hemodialysis patients. Methods This multicenter retrospective study included 1372 patients who underwent elective curative resection surgery for colon cancer between April 2016 and March 2020. Results Of the total patients, 19 (1.4%) underwent hemodialysis, of whom 19 (100%) had poor performance status and 18 had comorbidities (94.7%). Minimally invasive surgery was performed in 78.9% of hemodialysis patients. The postoperative complication rate was significantly higher in hemodialysis than non-hemodialysis patients (36.8% vs. 15.5%, p = 0.009). All postoperative complications in the hemodialysis patients were infectious type. Multivariate analysis revealed a significant association of hemodialysis with complications (odds ratio, 2.9362; 95%CI, 1.1384–7.5730; p = 0.026). Conclusion Despite recent advances in perioperative management and minimally invasive surgery, it is necessary to be aware that short-term complications can still occur, especially infectious complications in hemodialysis patients.

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POSTOPERATIVE INTRAABDOMINAL COMPLICATIONS IN COLON CANCER SURGERY COMPLICATED BY BOWEL OBSTRUCTION AND PERFORATION OF THE TUMOR

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2015-174-5-98-104 ◽

2015 ◽

Vol 174 (5) ◽

pp. 98-104 ◽

Cited By ~ 2

Author(s):

S. A. Aliev ◽

E. S. Aliev ◽

B. M. Zeinalov

Keyword(s):

Colon Cancer ◽

Surgical Treatment ◽

Postoperative Complications ◽

Retrospective Analysis ◽

Large Intestine ◽

Bowel Obstruction ◽

Abdominal Cavity ◽

Cancer Surgery ◽

Perioperative Prophylaxis ◽

Colon Cancer Surgery

The article presents a retrospective analysis of the results of surgical treatment of postoperative intraabdominal complications in 42 patients with colon cancer complicated by bowel obstruction and perforation of the tumor. The pyoinflammatory processes such as peritonitis and abscesses of abdominal cavity took a leading place in the structure of postoperative complications according to the authors. Method of «closed» decompression and intraluminal irrigation of the large intestine without wide opening of organ lumen was developed and applied into practice as perioperative prophylaxis of pyoinflammatory processes. These measures allowed reducing the rate of postoperative intraabdominal complications from 19,2 to 7,7%.

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