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Park L, McKechnie T, Lee Y, Tessier L, Passos E, Doumouras A, Hong D, Eskicioglu C. Short-term postoperative outcomes for obese versus non-obese inflammatory bowel disease patients undergoing bowel resection: a propensity score matched analysis. Int J Colorectal Dis 2024; 39:17. [PMID: 38194054 DOI: 10.1007/s00384-023-04588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Up to 40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is a well-known risk factor for increased perioperative morbidity, but this risk has never been quantified in IBD patients undergoing abdominal surgery using the United States National Inpatient Sample (NIS) database. This study aims to compare postoperative morbidity between obese and non-obese patients undergoing bowel resection for IBD using recent NIS data. METHODS Adult patients who underwent bowel resection for IBD from 2015 to 2019 were identified in the NIS using ICD-10-CM coding. Patients were stratified into obese (BMI > 30 kg/m2) and non-obese groups, then propensity score matched (PSM) for demographic, operative, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission healthcare costs, and length of stay (LOS). Univariable and multivariable regressions were utilized. RESULTS Overall, 6601 non-obese patients and 671 obese patients were identified. The PSM cohort included 659 patients per group. Obese patients had significantly increased odds of experiencing postoperative in-hospital morbidity (aOR 1.50, 95% CI 1.10-2.03, p = 0.010) compared to non-obese patients. Specifically, obese patients experienced increased gastrointestinal complications (aOR 1.49, 95% CI 1.00-2.24, p = 0.050), and genitourinary complications (aOR 1.71, 95% CI 1.12-2.61, p = 0.013). There were no differences in total admission healthcare costs (MD - $2256.32, 95% CI - 19,144.54-14,631.9, p = 0.79) or LOS (MD 0.16 days, 95% CI - 0.93-1.27, p = 0.77). CONCLUSIONS Obese IBD patients are at greater risk of postoperative in-hospital morbidity than non-obese IBD patients. This supports targeted preoperative weight loss protocols for IBD patients to optimize surgical outcomes.
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Affiliation(s)
- Lily Park
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yung Lee
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Léa Tessier
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Edward Passos
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aristithes Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East Hamilton, Hamilton, ON, L8N 4A6, Canada.
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Scheese D, Alwatari Y, Rustom S, He G, Puig CA, Julliard WA, Shah RD. Chest vs. neck anastomotic leak post esophagectomy for malignancy: rate, predictors, and outcomes. J Thorac Dis 2023; 15:3593-3604. [PMID: 37559658 PMCID: PMC10407498 DOI: 10.21037/jtd-23-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Anastomotic leak is a major contributor to comorbidity and mortality following esophagectomy. We sought to assess rate and predictors of leak after esophagectomy and compare outcomes of chest versus neck anastomotic leaks. METHODS A retrospective review was performed utilizing National-Surgical-Quality-Improvement-Program data from 2016-2019 for patients undergoing esophagectomy for malignancy. Preoperative characteristics and postoperative outcomes were compared. Patients were classified into two groups: Ivor Lewis esophagectomy [ILE, chest leak (CL)] and transhiatal esophagectomy (THE)/McKeown esophagectomy [ME, neck leak (NL)]. Multivariable regression models were constructed to determine predictors of each type of leak and postoperative complications. RESULTS A total of 1,665 patients underwent esophagectomy with 14.1% reported post-operative leak, 61% of patients underwent ILE while 39% underwent THE or ME. Of patients who underwent ILE, 13.8% had CL with complications including significantly higher length of stay and mortality compared to patients without leak. Independent predictors of CL included: diabetes, hypertension, advanced disease stage, chronic steroid use, and operative time. Ninety-five patients (14.6%) who underwent either THE or ME had NL with similar complications. Diabetes, pre-operative white blood cell (WBC), and operative time were independent predictors for NL. On multivariable regression, CL was associated with greater odds of requiring intervention compared with NL. CONCLUSIONS Post-esophagectomy CL and NL are associated with higher morbidity and mortality. Diabetes and operative time were independent predictors for both leaks while steroid use, hypertension, and advanced disease stage predicted CL. CL was associated with greater odds of needing an intervention, but contrary to conventional wisdom, was not associated with higher morbidity or mortality.
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Affiliation(s)
| | - Yahya Alwatari
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
| | - Salem Rustom
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
| | - Gene He
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
| | - Carlos A. Puig
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
| | - Walker A. Julliard
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
| | - Rachit D. Shah
- Virginia Commonwealth University, Section of Thoracic & Foregut Surgery, Department of Surgery, Richmond, VA, USA
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Engel RM, Oliva K, Centauri S, Wang W, McMurrick PJ, Yap R. Impact of Anastomotic Leak on Long-term Oncological Outcomes After Restorative Surgery for Rectal Cancer: A Retrospective Cohort Study. Dis Colon Rectum 2023; 66:923-933. [PMID: 36538716 DOI: 10.1097/dcr.0000000000002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anastomotic leak after restorative surgery for rectal cancer is a major complication and may lead to worse long-term oncological and survival outcomes. OBJECTIVE The purpose of this study was to identify risk factors associated with anastomotic leak and to assess the perioperative and long-term oncological impact of anastomotic leak in our cohort of patients with rectal cancer. DESIGN A retrospective analysis was performed on data from the prospectively maintained Cabrini Monash colorectal neoplasia database. Patients who had undergone rectal cancer resection and subsequently received anastomosis between November 2009 and May 2020 were included in this study. Patient and tumor characteristics, technical risk factors, and short-term and perioperative as well as long-term oncological and survival outcomes were assessed. SETTINGS The study was conducted in 3 tertiary hospitals. PATIENTS A total of 693 patients met the inclusion criteria for this study. MAIN OUTCOME MEASURES Univariate analyses were performed to assess the relationship between anastomotic leak and patient and technical risk factors, as well as perioperative and long-term outcomes. Univariate and multivariate proportional HR models of overall and disease-free survival were calculated. Kaplan-Meier survival analyses assessed disease-free and overall survival. RESULTS Anastomotic leak rate was 3.75%. Males had an increased risk of anastomotic leak, as did patients with hypertension and ischemic heart disease. Patients who experience an anastomotic leak were more likely to require reoperation and hospital readmission and were more likely to experience an inpatient death. Disease-free and overall survival were also negatively impacted by anastomotic leaks. LIMITATIONS This is a retrospective analysis of data from only 3 centers with the usual limitations. However, these effects have been minimized because of the high quality and completeness of the prospective data collection. CONCLUSIONS Anastomotic leaks after restorative surgery negatively affect long-term oncological and survival outcomes for patients with rectal cancer. See Video Abstract at http://links.lww.com/DCR/C81 . IMPACTO DE LA FUGA ANASTOMTICA EN LOS RESULTADOS ONCOLGICOS A LARGO PLAZO TRAS CIRUGA RESTAURADORA PARA EL CNCER DE RECTO UN ESTUDIO DE COHORTE RETROSPECTIVO ANTECEDENTES:La fuga anastomótica tras una cirugía restauradora para el cáncer de recto es una complicación mayor y puede conducir a peores resultados oncológicos y de supervivencia a largo plazo.OBJETIVO:El propósito de este estudio fue identificar los factores de riesgo asociados con la fuga anastomótica y evaluar el impacto oncológico perioperatorio y a largo plazo de la fuga anastomótica en nuestra cohorte de pacientes con cáncer de recto.DISEÑO:Se realizó un análisis retrospectivo de datos obtenidos de la base de datos Cabrini Monash sobre neoplasia colorrectal la cual es mantenida prospectivamente. Se incluyeron en este estudio pacientes que fueron sometidos a una resección del cáncer de recto y que posteriormente recibieron una anastomosis entre noviembre de 2009 y mayo de 2020. Se evaluaron las características del paciente y del tumor, los factores de riesgo relacionados a la técnica, los resultados oncológicos y de supervivencia perioperatorio, así como los resultados a corto y largo plazo.AJUSTES:El estudio se realizó en tres hospitales terciarios.PACIENTES:Un total de 693 pacientes cumplieron con los criterios de inclusión para este estudio.PRINCIPALES MEDIDAS DE RESULTADO:Se realizaron análisis univariados para evaluar la relación entre la fuga anastomótica y aquellos factores relacionados al paciente, a la técnica, así como los resultados perioperatorios y a largo plazo. Se calcularon modelos de razón de riesgo proporcional univariante y multivariante de supervivencia global y libre de enfermedad. Los análisis de supervivencia de Kaplan-Meier evaluaron la supervivencia libre de enfermedad y la supervivencia global.RESULTADOS:La tasa de fuga anastomótica fue del 3,75%. Los hombres tenían un mayor riesgo de fuga anastomótica al igual que aquellos pacientes con hipertensión y cardiopatía isquémica. Los pacientes que sufrieron una fuga anastomótica tuvieron mayores probabilidades de requerir una reintervención y reingreso hospitalario, así como también tuvieron mayores probabilidades de sufrir una muerte hospitalaria. La supervivencia libre de enfermedad y general también se vio afectada negativamente por las fugas anastomóticas.LIMITACIONES:Este es un análisis retrospectivo de datos de solo tres centros con las limitaciones habituales. Sin embargo, estos efectos han sido minimizados debido a la alta calidad y la exhaustividad de la recopilación prospectiva de datos.CONCLUSIONES:Las fugas anastomóticas después de una cirugía restauradora afectan negativamente los resultados oncológicos y de supervivencia a largo plazo para los pacientes con cáncer de recto. Consulte Video Resumen en http://links.lww.com/DCR/C81 . (Traducción-Dr. Osvaldo Gauto ).
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Affiliation(s)
- Rebekah M Engel
- Department of Surgery, Cabrini Health, Cabrini Monash University, Malvern, Victoria, Australia
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Karen Oliva
- Department of Surgery, Cabrini Health, Cabrini Monash University, Malvern, Victoria, Australia
| | - Suellyn Centauri
- Department of Surgery, Cabrini Health, Cabrini Monash University, Malvern, Victoria, Australia
| | - Wei Wang
- Cabrini Institute, Malvern, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul J McMurrick
- Department of Surgery, Cabrini Health, Cabrini Monash University, Malvern, Victoria, Australia
| | - Raymond Yap
- Department of Surgery, Cabrini Health, Cabrini Monash University, Malvern, Victoria, Australia
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Simillis C, Charalambides M, Mavrou A, Afxentiou T, Powar MP, Wheeler J, Davies RJ, Fearnhead NS. Operative blood loss adversely affects short and long-term outcomes after colorectal cancer surgery: results of a systematic review and meta-analysis. Tech Coloproctol 2023; 27:189-208. [PMID: 36138307 DOI: 10.1007/s10151-022-02701-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this meta-analysis was to assess the impact of operative blood loss on short and long-term outcomes following colorectal cancer surgery. METHODS A systematic literature review and meta-analysis were performed, from inception to the 10th of August 2020. A comprehensive literature search was performed on the 10th of August 2020 of PubMed MEDLINE, Embase, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials. Only studies reporting on operative blood loss and postoperative short term or long-term outcomes in colorectal cancer surgery were considered for inclusion. RESULTS Forty-three studies were included, reporting on 59,813 patients. Increased operative blood loss was associated with higher morbidity, for blood loss greater than 150-350 ml (odds ratio [OR] 2.09, p < 0.001) and > 500 ml (OR 2.29, p = 0.007). Anastomotic leak occurred more frequently for blood loss above a range of 50-100 ml (OR 1.14, p = 0.007), 250-300 ml (OR 2.06, p < 0.001), and 400-500 ml (OR 3.15, p < 0.001). Postoperative ileus rate was higher for blood loss > 100-200 ml (OR 1.90, p = 0.02). Surgical site infections were more frequent above 200-500 ml (OR 1.96, p = 0.04). Hospital stay was increased for blood loss > 150-200 ml (OR 1.63, p = 0.04). Operative blood loss was significantly higher in patients that suffered morbidity (mean difference [MD] 133.16 ml, p < 0.001) or anastomotic leak (MD 69.56 ml, p = 0.02). In the long term, increased operative blood loss was associated with worse overall survival above a range of 200-500 ml (hazard ratio [HR] 1.15, p < 0.001), and worse recurrence-free survival above 200-400 ml (HR 1.33, p = 0.01). Increased blood loss was associated with small bowel obstruction caused by colorectal cancer recurrence for blood loss higher than 400 ml (HR 1.97, p = 0.03) and 800 ml (HR 3.78, p = 0.02). CONCLUSIONS Increased operative blood loss may adversely impact short term and long-term postoperative outcomes. Measures should be taken to minimize operative blood loss during colorectal cancer surgery. Due to the uncertainty of evidence identified, further research, with standardised methodology, is required on this important subject.
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Affiliation(s)
- C Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - M Charalambides
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Mavrou
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - T Afxentiou
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - M P Powar
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N S Fearnhead
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Ewnte B, Girma E. Ileo-sigmoid knotting in a female Ethiopian patient, a case report. Int J Surg Case Rep 2022; 95:107217. [PMID: 35609479 PMCID: PMC9126768 DOI: 10.1016/j.ijscr.2022.107217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Ileo-sigmoid knotting is a very rare cause of bowel obstruction. The diagnosis can be challenging and may not be suspected pre-operatively. A high index of suspicion, especially in areas of the “sigmoid belt” region, can be helpful. Case presentation A 40-year-old ethnic Amhara female patient presented with symptoms and signs of bowel obstruction. She presented in shock and after resuscitation, laparotomy revealed gangrenous ileum twisted around the sigmoid colon (‘ileo-sigmoid knotting’). The gangrenous ileal segment was resected, with end-to-end ileo-ileal anastomosis. The patient had a smooth postoperative course and was discharged on the 4th post-operative day. Conclusions Twisting of the ileum around the sigmoid colon is pathognomonic of ileo-sigmoid knotting. Prompt resuscitation and surgical intervention in the shocked patient with an acute abdomen and evidence of intestinal obstruction could be life-saving.
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Affiliation(s)
- Biniam Ewnte
- Department of Surgery, School of Medicine, Debre Tabor University, Ethiopia.
| | - Eleni Girma
- Department of Medicine, Debre Tabor University, Ethiopia
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Lizano-Díez I, Poteet S, Burniol-Garcia A, Cerezales M. The burden of perioperative hypertension/hypotension: A systematic review. PLoS One 2022; 17:e0263737. [PMID: 35139104 PMCID: PMC8827488 DOI: 10.1371/journal.pone.0263737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Study objective Our goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting. Methods We conducted a systematic peer review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, their definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values; and they were classified according to the type of surgery (cardiac and non-cardiac). Results A total of 3,680 articles were identified, and 66 articles fulfilled the criteria for data extraction. For the perioperative setting, the number of articles varies by outcome: 20 mortality, 16 renal outcomes, 6 stroke, 7 delirium and 34 other outcomes. Hypotension was reported to be associated with mortality (OR 1.02–20.826) as well as changes from the patient’s baseline blood pressure (BP) (OR 1.02–1.36); hypotension also had a role in the development of acute kidney injury (AKI) (OR 1.03–14.11). Postsurgical delirium was found in relation with BP lability (OR 1.018–1.038) and intra- and postsurgical hypotension (OR 1.05–1.22), and hypertension (OR 1.44–2.34). Increased OR (37.67) of intracranial hemorrhage was associated to postsurgical systolic BP >130 mmHg. There was a wide range of additional diverse outcomes related to hypo-, hypertension and BP lability. Conclusions The perioperative management of BP influences short- and long-term effects of surgical procedures in cardiac and non-cardiac interventions; these findings support the burden of BP fluctuations in this setting.
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7
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A systematic review of the literature assessing operative blood loss and postoperative outcomes after colorectal surgery. Int J Colorectal Dis 2022; 37:47-69. [PMID: 34697662 DOI: 10.1007/s00384-021-04015-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE There is no consensus in the literature regarding the association between operative blood loss and postoperative outcomes in colorectal surgery, despite evidence suggesting a link. Therefore, this systematic review assesses the association between operative blood loss, perioperative and long-term outcomes after colorectal surgery. METHODS A literature search of MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane was performed to identify studies reporting on operative blood loss in colorectal surgery. RESULTS The review included forty-nine studies reporting on 61,312 participants, with a mean age ranging from 53.4 to 78.1 years. The included studies demonstrated that major operative blood loss was found to be a risk factor for mortality, anastomotic leak, presacral abscess, and postoperative ileus, leading to an increased duration of hospital stay. In the long term, the studies suggest that significant blood loss was an independent risk factor for future small bowel obstruction due to colorectal cancer recurrence and adhesions. Studies found that survival was significantly reduced, whilst the risk of colorectal cancer recurrence was increased. Reoperation and cancer-specific survival were not associated with major blood loss. CONCLUSION The results of this systematic review suggest that major operative blood loss increases the risk of perioperative adverse events and has short and long-term repercussions on postoperative outcomes. Laparoscopic and robotic surgery, vessel ligation technology and anaesthetic considerations are essential for reducing blood loss and improving outcomes. This review highlights the need for further high quality, prospective, multicentre trials with a greater number of participants, and accurate and standardised methods of measuring operative blood loss.
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9
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Örhalmi J, Turek Z, Dolejš J, Páral J, Malý O, Čečka F. Analysis of Cumulative Fluid Balance Impact on the Stability of Gastrointestinal Tract Anastomosis. Indian J Surg 2021; 84:185-189. [PMID: 33814811 PMCID: PMC8008214 DOI: 10.1007/s12262-021-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
Anastomotic leakage is a serious postoperative complication following a low anterior resection of rectum. Current research in colorectal surgery focuses on searching for techniques which could minimize the risk of leakage. The main objective of this study was to evaluate the impact of cumulative fluid balance on microcirculatory changes at the anastomotic site.This experimental study used 15 domestic pigs; all of the animals underwent rectal resection. Then the animals were divided into three groups and received IV crystalloids at various rates, i.e. 5 ml/kg/h; 10 ml/kg/h; and 20 ml/kg/h. Large bowel micro-perfusion was measured using laser Doppler flowmetry during and following the surgical procedure.The experiments were successfully performed in all 15 cases. No animal died during the procedure or during the follow-up. We found no differences in micro-perfusion of the bowel between the experimental groups during the surgical procedure and during the follow-up period after the surgery. A significant decrease in micro-perfusion was observed after the transection of the inferior mesenteric artery in all the groups; again, no differences between the groups were observed.We did not confirm the original hypothesis that excessive load of IV crystalloids during the surgery would have a negative effect on bowel micro-perfusion and thus a negative effect on the healing of the anastomosis. However, laser Doppler flowmetry was found to have high accuracy in measuring tissue microcirculation and has the potential to be used in clinical practice.
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Affiliation(s)
- Julius Örhalmi
- Department of Surgery, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Zdeněk Turek
- Department for Anaesthesiology, Intensive Care and Resuscitation, Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Josef Dolejš
- Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Páral
- Department of Surgery, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic.,Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Ondřej Malý
- Department of Surgery, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic.,Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Filip Čečka
- Department of Surgery, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, 500 05 Hradec Králové, Czech Republic
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10
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Wijnberge M, Schenk J, Bulle E, Vlaar AP, Maheshwari K, Hollmann MW, Binnekade JM, Geerts BF, Veelo DP. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open 2021; 5:6073395. [PMID: 33609377 PMCID: PMC7893468 DOI: 10.1093/bjsopen/zraa018] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality. Methods MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity. Results The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent. Conclusion Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic.
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Affiliation(s)
- M Wijnberge
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J Schenk
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E Bulle
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A P Vlaar
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Maheshwari
- Department of General Anaesthesiology, Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J M Binnekade
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B F Geerts
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - D P Veelo
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Teixeira Farinha H, Martin D, Ramó A, Hübner M, Demartines N, Hahnloser D. Proposition of a simple binary grading of estimated blood loss during colon surgery. Int J Colorectal Dis 2021; 36:2111-2117. [PMID: 33864102 PMCID: PMC8426219 DOI: 10.1007/s00384-021-03925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Intraoperative estimated blood loss (EBL) is often reported in nearly all surgical papers; however, there is no consensus regarding its measurement. The aim of this study was to determine whether EBL (ml) is as reliable and reproducible in predicting complications as a simple binary grading of EBL. METHODS All consecutive patients undergoing colectomies between January 2015 and December 2018 were included. EBL was assessed prospectively by the surgeon and anaesthesiologist in ml and with a binary scale: bleeding "as usual" versus "more than usual" by the surgeon. Differences between pre- and post-operative haemoglobin levels (ΔHb g/dl) were correlated to EBL. Blood loss impact on 30-day postoperative morbidity was analysed. RESULTS A total of 270 patients were included, with a mean age of 65 years (SD 17). Mean EBL documented by surgeons correlated to EBL by anaesthesiologists (79.5 ml, SD 99 vs. 84.5 ml, SD 118, ϱ = 0.926, p < 0.001). Surgeons and anaesthesiologists' EBL correlated also with ΔHb (ϱ = - 0.273, p = 0.01 and ϱ = - 0.344, p = 0.01, respectively). Patient with surgeon EBL ≥ 250 ml or graded as "more than usual" bleeding had significantly more severe complications (8% vs. 20%, p = 0.02 and 8% vs. 27%, p = 0.001, respectively). CONCLUSION Anaesthesiologist and surgeon's EBL correlated with ΔHb. Simple grading of blood loss as "usual" and "more than usual" predicted severe complications and higher mortality rates. This simple binary grading of blood loss in colon surgery could be an alternative to the estimation of blood loss in ml as it is easy to apply but needs to be validated externally.
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Affiliation(s)
- Hugo Teixeira Farinha
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Martin
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Audrey Ramó
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Furukawa K, Gocho T, Sakamoto T, Tsunematsu M, Haruki K, Horiuchi T, Shirai Y, Yasuda J, Shiozaki H, Onda S, Shiba H, Sato S, Takahashi H, Ikegami T. Intraoperative amylase level of pancreatic juice as a simple predictor of pancreatic fistula after pancreaticoduodenectomy. Pancreatology 2021; 21:299-305. [PMID: 33214083 DOI: 10.1016/j.pan.2020.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A soft remnant texture of the pancreas is commonly accepted as a risk factor for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). However, its assessment is subjective. The aim of this study was to evaluate the significance of intraoperative amylase level of the pancreatic juice as a risk factor of POPF after PD. METHOD This study included 75 patients who underwent PD between November 2014 and April 2020 at Jikei University Hospital. We investigated the relationship between pancreatic texture, intraoperative amylase level of pancreatic juice, results of the pathological evaluations, and the incidence of POPF. RESULTS Twenty-three patients (31%) developed POPF. The significant predictors of POPF were non-ductal adenocarcinoma (p < 0.01), soft pancreatic remnant (p < 0.01), high intraoperative blood loss (p < 0.01), high intraoperative amylase level of pancreatic juice (p < 0.01), and low pancreatic fibrosis (p < 0.01). Multivariate analysis revealed that the significant independent predictors of POPF were high intraoperative blood loss (p < 0.01) and high intraoperative amylase level of pancreatic juice (p = 0.02). Receiver operating characteristic (ROC) analysis showed that the cut-off value for the intraoperative amylase level of pancreatic juice was 2.17 × 105 IU/L (area under the curve = 0.726, sensitivity = 95.7%, and specificity = 50.0%) CONCLUSIONS: The intraoperative amylase level of pancreatic juice is a reliable objective predictor for POPF after PD.
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Affiliation(s)
- Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Taro Sakamoto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masashi Tsunematsu
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koichiro Haruki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Horiuchi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jungo Yasuda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hironori Shiozaki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Vigueras Smith A, Sumak R, Cabrera R, Kondo W, Ferreira H. Bowel anastomosis leakage following endometriosis surgery: an evidence based analysis of risk factors and prevention techniques. Facts Views Vis Obgyn 2020; 12:207-225. [PMID: 33123696 PMCID: PMC7580259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Deep endometriosis most commonly involves the rectosigmoid junction and its management often requires a colorectal resection. Anastomotic leakage is a severe complication after resection and affects 1-6% of the cases. OBJECTIVE To evaluate the risk factors related to anastomotic leakage following endometriosis sur-gery, its prevention techniques and the role of protective stomas. METHODS A comprehensive literature review was carried out for English-language publications in Pubmed and Google Scholar. We included all studies including the following MeSH terms and key words: Anastomotic leakage AND bowel surgery OR Endometriosis OR Colorectal surgery OR Bowel endometriosis. Two authors independently made a selection and analysed relevant abstracts according to the aim of this review. RESULTS Risk factors and preventive measures were categorised considering the patient condition, the intra- operative setting and the surgical procedure itself. Level I and II recommendations include modifiable risk factors such as the use of stapled or handsewn anastomosis; intra-operative air leak test to check the integrity of the anastomosis; systematic use of pelvic and trans-anal drainage; application of protective or ghost ileostomy in low rectal resections; vaginal closure before the bowel resection; use of oral antibiotics the day before surgery and performing partial mesorectal resection near the bowel wall. Diverting stomas may decrease the morbidity and the clinical consequences of leakage over 65% of low rectal resections but may cause significant adverse effects. CONCLUSION Evidence-based protective actions are crucial to reduce clinical consequences of anastomotic leakage and to minimise the use of protective stomas in endometriosis surgery.
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Affiliation(s)
- A Vigueras Smith
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Sumak
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Cabrera
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - W Kondo
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - H Ferreira
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
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Pryn PS, Polovinkin VV. [Splenic flexure mobilization in surgery for rectal cancer]. Khirurgiia (Mosk) 2020:94-99. [PMID: 31994507 DOI: 10.17116/hirurgia202001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nowadays, the issue of splenic flexure mobilization (SFM) in anterior and low anterior rectal resection for rectal cancer is still debatable. This stage is important because dissection results tension-free anastomosis and excision of specimen of enough length with adequate number of harvested lymph nodes. However, literature review confirmed the absence of agreement regarding reduced incidence of colorectal anastomotic leakage and improved long-term oncologic outcomes after SFM. Opinion about selective approach to this procedure is becoming more common. Therefore, randomized trials are necessary to determine a need for routine SFM or indications for selective approach to SFM in anterior rectal resection for rectal cancer.
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Affiliation(s)
- P S Pryn
- Research Institute - Ochapovsky Regional Clinical Hospital No.1 of the Ministry of Health of the Krasnodar Region, Krasnodar, Russia
| | - V V Polovinkin
- Research Institute - Ochapovsky Regional Clinical Hospital No.1 of the Ministry of Health of the Krasnodar Region, Krasnodar, Russia
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15
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Sánchez-Guillén L, Frasson M, García-Granero Á, Pellino G, Flor-Lorente B, Álvarez-Sarrado E, García-Granero E. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques. Ann R Coll Surg Engl 2019; 101:571-578. [PMID: 31672036 PMCID: PMC6818057 DOI: 10.1308/rcsann.2019.0098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). MATERIALS AND METHODS This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. RESULTS We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. CONCLUSION Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.
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Affiliation(s)
| | - M Frasson
- Colorectal Surgery, University Hospital La Fe, Valencia, Spain
| | | | - G Pellino
- Colorectal Surgery, University Hospital La Fe, Valencia, Spain
| | - B Flor-Lorente
- Colorectal Surgery, University Hospital La Fe, Valencia, Spain
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Pouwels S, Van Genderen ME, Kreeftenberg HG, Ribeiro R, Parmar C, Topal B, Celik A, Ugale S. Utility of the cold pressor test to predict future cardiovascular events. Expert Rev Cardiovasc Ther 2019; 17:305-318. [PMID: 30916592 DOI: 10.1080/14779072.2019.1598262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The cold pressor test (CPT) is a common and extensively validated test, which induces systemic stress involving immersion of an individual's hand in ice water (normally temperature between 0 and 5 degrees Celsius) for a period of time. CPT has been used in various fields, like examining effects of stress on memory, decision-making, pain and cardiovascular health. Areas covered: In terms of cardiovascular health, current research is mainly interested in predicting the occurrence of cardiovascular (CV) events. The objective of this review is to give an overview of the history and methodology of the CPT, and clinical utility in possibly predicting CV events in CAD and other atherosclerotic diseases. Secondly, we will discuss possible future applications of the CPT in clinical care. Expert opinion: An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction. Regarding the physiological mechanism of the CPT and its effect on the measurements of the carotid artery reactivity even less is known.
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Affiliation(s)
- Sjaak Pouwels
- a Department of Surgery , Franciscus Gasthuis & Vlietland , Rotterdam/Schiedam , The Netherlands
| | - Michel E Van Genderen
- b Department of Internal Medicine , Franciscus Gasthuis & Vlietland , Rotterdam/Schiedam , The Netherlands
| | - Herman G Kreeftenberg
- c Department of Internal Medicine , Catharina Hospital , Eindhoven , The Netherlands.,d Department of Intensive Care Medicine , Catharina Hospital , Eindhoven , The Netherlands
| | - Rui Ribeiro
- e Metabolic Patient Multidisciplinary Centre , Clínica de Santo António , Lisbon , Portugal
| | - Chetan Parmar
- f Department of Surgery , Whittington Hospital , London , UK
| | - Besir Topal
- g Department of Cardiothoracic Surgery , OLVG , Amsterdam , The Netherlands
| | - Alper Celik
- h Department of metabolic surgery , Metabolic Surgery Clinic , Istanbul , Turkey
| | - Surendra Ugale
- i Department of Surgery , Virinchi Hospitals , Hyderbad , India
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17
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Venara A, Jaouen R, Lermite E, Le Naoures P, Casa C, Mirallié E, Duchalais E, Hamy A. The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery. World J Surg 2019; 43:252-259. [PMID: 30109387 DOI: 10.1007/s00268-018-4757-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Arterial perfusion defects are a risk factor for anastomotic leakage (AL) following colorectal surgery. Measuring arterial stiffness using pulse wave velocity (PWV) is known to reflect the performance of the arterial network. The objective of this study was to assess the predictive value of PWV for AL after colorectal surgery. METHODS A prospective monocentric study was conducted on all consecutive patients who underwent colorectal surgery scheduled between March 1, 2016 and May 1, 2017. Patients were divided into two groups according to the PWV which was measured preoperatively using the pOpmètre® device: PWV+ (PWV > 10 m/s) and PWV- (PWV ≤ 10 m/s). We then compared the PWV+ and PWV- groups. The primary endpoint was the AL rate. RESULTS A total of 96 patients were studied, including 60 in the PWV- group and 36 in the PWV+ group. Patients in the PWV+ group were more at risk of presenting with AL than those in the PWV- group (6.25 vs 0%) (p = 0.002). There was no difference in immediate postoperative complications between the two groups apart from the length of hospital stay. PWV predicted the appearance of AL with a sensitivity of and a negative predictive value of 100%. CONCLUSION Measuring PWV could be a used as a predictive examination in the early detection of AL after colorectal surgery.
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Affiliation(s)
- A Venara
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France.
- Angers Medical University, Angers, France.
- INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l'appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France.
| | - R Jaouen
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France
- Angers Medical University, Angers, France
| | - E Lermite
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France
- Angers Medical University, Angers, France
| | - P Le Naoures
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - C Casa
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - E Mirallié
- Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - E Duchalais
- INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l'appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France
- Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - A Hamy
- Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933, Angers Cedex 9, France
- Angers Medical University, Angers, France
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Chen YW, Huang MT, Chang TC. Long term outcomes of simultaneous laparoscopic versus open resection for colorectal cancer with synchronous liver metastases. Asian J Surg 2018; 42:217-223. [PMID: 29804706 DOI: 10.1016/j.asjsur.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE Because of the advancements in the surgical techniques of liver resection and improvements in anesthesia and postoperative critical care, the simultaneous resection of synchronous colorectal cancer with liver metastasis either by the laparoscopic procedure or by the open resection method has been considered as a safe and acceptable option. However, there is limited information on the comparison of postoperative outcomes between laparoscopic surgery and open surgery. This study investigated the clinical results and postoperative outcomes of laparoscopic simultaneous resection of synchronous colorectal cancer with liver metastasis in comparison with those of open surgery. METHODS Patients with synchronous colorectal cancer and liver metastasis who underwent simultaneous resection at Shuang Ho Hospital from 2009 to 2017 were identified. The patient demographics, perioperative morbidity, and survival rates were analyzed. RESULTS A total of 38 patients underwent simultaneous resection of synchronous colorectal cancer with liver metastasis. Laparoscopic procedure was performed for 16 patients, and the remaining 22 patients underwent open surgery. No significant differences were observed in the patient characteristics between the two groups. There was no perioperative mortality in both groups. The 1- and 3-year disease-free survival rates were 56% and 35% in the laparoscopic group and 70% and 15% in the open surgery group, respectively. The 1- and 3-year overall survival rates were 100% and 84% in the laparoscopic group and 73% and 48% in the open surgery group, respectively. CONCLUSION In selected patients, laparoscopic surgery for simultaneous resection of synchronous colorectal cancer with liver metastasis seems to be safe and had a similar outcome to that of open surgery.
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Affiliation(s)
- Ying-Wei Chen
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei, Taiwan; Department of surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City. 235, Taiwan.
| | - Ming-Te Huang
- Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei, Taiwan; Department of surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City. 235, Taiwan.
| | - Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taiwan; Graduate Institute of Clinical Medicine, Taipei Medical University, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Department of surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City. 235, Taiwan.
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de Raaff CA, Kalff MC, Coblijn UK, de Vries CE, de Vries N, Bonjer HJ, van Wagensveld BA. Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery. Surg Obes Relat Dis 2018; 14:186-190. [DOI: 10.1016/j.soard.2017.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
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20
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Jeong DS, Kim YH, Kim KJ. Surgical Outcomes and Risk Factors in Patients Who Underwent Emergency Colorectal Surgery. Ann Coloproctol 2017; 33:239-244. [PMID: 29354607 PMCID: PMC5768479 DOI: 10.3393/ac.2017.33.6.239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Emergency colorectal surgery has high rates of complications and mortality because of incomplete bowel preparation and bacterial contamination. The authors aimed to evaluate the surgical outcomes and the risk factors for the mortality and the complication rates of patients who underwent emergency surgery to treat colorectal diseases. Methods This is a prospective study from January 2014 to April 2016, and the results are based on a retrospective analysis of the clinical results for patients who underwent emergency colorectal surgery at Chosun University Hospital. Results A total of 99 patients underwent emergency colorectal surgery during the study period. The most frequent indication of surgery was perforation (75.8%). The causes of disease were colorectal cancer (19.2%), complicated diverticulitis (21.2%), and ischemia (27.2%). There were 27 mortalities (27.3%). The major morbidity was 39.5%. Preoperative hypotension and perioperative blood transfusion were independent risk factors for both morbidity and mortality. Conclusion These results revealed that emergency colorectal surgeries are associated with significant morbidity and mortality. Furthermore, the independent risk factors for both morbidity and mortality in such patiients were preoperative hypotension and perioperative transfusion.
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Affiliation(s)
- Dai Sik Jeong
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Young Hun Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Kyung Jong Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
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Nakagawa A, Nakamura T, Oshikiri T, Hasegawa H, Yamamoto M, Kanaji S, Matsuda Y, Yamashita K, Matsuda T, Sumi Y, Suzuki S, Kakeji Y. The Surgical Apgar Score Predicts Not Only Short-Term Complications But Also Long-Term Prognosis After Esophagectomy. Ann Surg Oncol 2017; 24:3934-3946. [PMID: 28986819 DOI: 10.1245/s10434-017-6103-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The surgical Apgar score (SAS) quantifies three intraoperative factors and predicts postoperative complications, but few reports describe its usefulness in esophagectomy, and no studies to date show its correlation with long-term prognosis after esophagectomy. METHODS This study investigated 400 cases in which esophagectomy was performed on esophageal malignant tumors at the authors' hospital from January 2007 to January 2017. In this study, SAS was defined as the sum of the scores of three parameters, namely, estimated blood loss, lowest mean arterial pressure, and lowest heart rate, with values extracted from medical records. Postoperative complications classified as Clavien-Dindo grade 3 or higher were also extracted. The study retrospectively compared the relationship of SAS to postoperative complications and survival. RESULTS Univariate analysis showed that postoperative complications were significantly associated with hypertension (p = 0.017), thoracotomy (p = 0.012), and SAS ≤ 5 (p < 0.0001), and multivariate analysis showed that hypertension (p = 0.049) and SAS ≤ 5 (p < 0.0001) were significant predictive factors for complications. In the prognostic analysis, log-rank analysis showed that patients with an SAS ≤ 5 had a significantly poorer prognosis than those with a SAS > 5 (p = 0.043), especially for complications classified as clinical stage 2 or higher (p = 0.027). In the multivariate analysis, SAS ≤ 5 was identified as a significantly poor prognostic factor for complications classified as clinical stage 2 or higher (p = 0.029). CONCLUSION In this study, SAS was useful not only for predicting short-term complications, but also as a long-term prognostic factor after esophagectomy.
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Affiliation(s)
- Akio Nakagawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeru Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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22
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van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, Slooter GD. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg 2016; 36:183-200. [PMID: 27756644 DOI: 10.1016/j.ijsu.2016.09.098] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation. METHODS Two independent literature searches were performed using EMBASE, Pubmed and Cochrane databases. Both clinical and experimental studies published in English from 1985 to August 2015 were included. The main outcome measure was the risk of anastomotic leakage and other postoperative complications during colorectal surgery. Determined risk factors of CAL were stated as strong evidence (level I and II high quality studies), and potential risk factors as either moderate evidence (experimental studies level III), or weak evidence (level IV or V studies). RESULTS The final analysis included 117 articles. Independent factors of CAL are diabetes mellitus, hyperglycemia and a high HbA1c, anemia, blood loss, blood transfusions, prolonged operating time, intraoperative events and contamination and a lack of antibiotics. Unequivocal are data on blood pressure, the use of inotropes/vasopressors, oxygen suppletion, type of analgesia and goal directed fluid therapy. No studies could be found identifying the impact of body core temperature or mean arterial pressure on CAL. Subjective factors such as the surgeons' own assessment of local perfusion and visibility of the operating field have not been the subject of relevant studies for occurrence in patients with CAL. CONCLUSION Both surgery related and non-surgery related risk factors that can be modified must be identified to improve colorectal care. Surgeons and anesthesiologists should cooperate on these items in their continuous effort to reduce the number of CAL. A registration study determining individual intraoperative risk factors of CAL is currently performed as a multicenter cohort study in the Netherlands.
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Affiliation(s)
- S J van Rooijen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands.
| | - D Huisman
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - M Stuijvenberg
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - J Stens
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - R M H Roumen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - F Daams
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - G D Slooter
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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23
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Kim CN. Emergent Colorectal Surgery: What Should Be Considered? Ann Coloproctol 2016; 32:124-5. [PMID: 27626020 PMCID: PMC5019962 DOI: 10.3393/ac.2016.32.4.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chang-Nam Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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24
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Oh NH, Kim KJ. Outcomes and Risk Factors Affecting Mortality in Patients Who Underwent Colorectal Emergency Surgery. Ann Coloproctol 2016; 32:133-8. [PMID: 27626023 PMCID: PMC5019965 DOI: 10.3393/ac.2016.32.4.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/04/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose Emergency colorectal surgery has a high risk of mortality and morbidity because of incomplete bowel preparation, bacterial proliferation, and contamination. In this study, we investigated the outcomes and the risk factors affecting mortality in patients who had undergone emergency surgery for the treatment of various colorectal diseases. Methods This study is a retrospective analysis of prospectively collected data to survey the clinical results for patients who had undergone emergency colorectal surgery from January 2014 to December 2014. We analyzed various clinicopathologic factors, which were divided into 3 categories: preoperative, intraoperative, and postoperative. Results A total of 50 patients had undergone emergency colorectal surgery during the time period covered by this study. Among them, 10 patients (20%) died during the postoperative period. A simple linear regression analysis showed that the risk factors for mortality were old age, preoperative hypotension, and a high American Society of Anesthesiologist (ASA) score. Moreover, a multiple linear regression analysis showed a high ASA score and preoperative hypotension to be independent risk factors. Conclusion In this study, emergency colorectal surgery showed a relatively high mortality rate. Furthermore, the independent risk factors for mortality were preoperative hypotension and high ASA score; thus, patients with these characteristics need to be evaluated more carefully and receive better care if the mortality rate is to be reduced.
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Affiliation(s)
- Nam Ho Oh
- Department of Surgery, Chosun University Medical School, Gwangju, Korea
| | - Kyung Jong Kim
- Department of Surgery, Chosun University Medical School, Gwangju, Korea
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25
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Nienhuijs SW, Kaymak U, Korsten E, Buise MP. Influence of intraoperative hypotension on leaks after sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:535-539. [DOI: 10.1016/j.soard.2015.08.506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/13/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
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26
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Piccioni F, Mariani L, Negri M, Casiraghi C, Belli F, Leo E, Langer M. Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer: A retrospective study on 1,474 patients. J Surg Oncol 2015. [DOI: 10.1002/jso.23966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Federico Piccioni
- Department of Anesthesia, Intensive Care and Palliative Care; Fondazione Istituto Nazionale dei Tumori; Milan Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - Marta Negri
- Anesthesia and Intensive Care Unit; Azienda Ospedaliera Treviglio; Treviglio Italy
| | - Claudia Casiraghi
- School of Anesthesia and Intensive Care; University of Milan; Milan Italy
| | - Filiberto Belli
- Colorectal Cancer Unit-Department of Surgery; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - Ermanno Leo
- Colorectal Cancer Unit-Department of Surgery; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - Martin Langer
- Department of Anesthesia, Intensive Care and Palliative Care; Fondazione Istituto Nazionale dei Tumori; Milan Italy
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
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27
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Ishino Y, Saigusa S, Ohi M, Yasuda H, Tanaka K, Toiyama Y, Mohri Y, Kusunoki M. Preoperative C-reactive protein and operative blood loss predict poor prognosis in patients with gastric cancer after laparoscopy-assisted gastrectomy. Asian J Endosc Surg 2014; 7:287-94. [PMID: 25123708 DOI: 10.1111/ases.12126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/15/2014] [Accepted: 06/12/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to clarify the factors associated with postoperative complications and prognoses following laparoscopy-assisted gastrectomy for gastric cancer. METHODS A total of 214 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer were enrolled in this retrospective study. Factors that were potentially associated with postoperative complications and prognosis were assessed using the following clinical and perioperative parameters: the Estimation of Physiologic Ability and Surgical Stress scoring system, the Prognostic Nutritional Index, and the Clavien-Dindo classification. RESULTS Postoperative complications developed in 18.7% of patients. Blood loss ≥ 1% of body weight was significantly correlated with anastomotic leakage (P = 0.0108). Severe complications, based on the Clavien-Dindo classification, were more frequent in patients with proximal or total gastrectomies (P = 0.0324). A preoperative C-reactive protein level > 0.5 mg/dL, blood loss > 1% of body weight, age ≥ 70 years at the time of operation, and an Estimation of Physiologic Ability and Surgical Stress score ≥ 0.2 were significantly correlated with poor prognosis. Multivariate analysis revealed that two of these factors, preoperative C-reactive protein level ≥ 0.5 mg/dL and operative blood loss ≥ 1% of body weight, were independent prognostic factors (P = 0.0376 and P = 0.0112, respectively). The Prognostic Nutritional Index had no significant correlation with prognosis or the occurrence of postoperative complications. CONCLUSION Operative blood loss ≥ 1% of body weight and type of resection were associated with an increased frequency of postoperative complications, while preoperative C-reactive protein levels and operative blood loss may be prognostic predictors for gastric cancer patients following laparoscopy-assisted gastrectomy.
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Affiliation(s)
- Yoshito Ishino
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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28
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van Vugt JLA, Reisinger KW, Derikx JPM, Boerma D, Stoot JHMB. Improving the outcomes in oncological colorectal surgery. World J Gastroenterol 2014; 20:12445-12457. [PMID: 25253944 PMCID: PMC4168077 DOI: 10.3748/wjg.v20.i35.12445] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 03/18/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.
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29
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Risk factor evaluation for postoperative complications in laparoscopic colorectal surgery by a classic severity grading system. Tumour Biol 2014; 35:8115-23. [PMID: 24840635 DOI: 10.1007/s13277-014-2016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/23/2014] [Indexed: 01/27/2023] Open
Abstract
Using the uniform complication grading system to evaluate postoperative complications after laparoscopic colorectal surgery is the purpose of the present study. Surgical complications were defined as grades I, II, III, IV, and V recommended by Dindo et al. Patients were categorized into three pairs: complication group (CG) and non-complication group (NCG), minor complication group (MiCG, grades I-II) and non-minor complication group (NMiCG), and major complication group (MaCG, grades III-V) and non-major complication group (NMaCG); of the 570 patients, 431 patients were discharged with no complications, and 174 complications occurred in 119 patients. The percent of grades I, II, III, IV, and V complications were 4.7, 20, 4.7, 0.7, and 0.4 %, respectively. Complications were significantly associated with male gender, larger tumor volume, and more estimated blood loss (EBL). The multivariate analysis revealed that male and EBL ≥150 ml were found to be independent predictors of postoperative complications. In subgroup analysis, patients with larger tumor volume were at significantly higher risk of postoperative major complications, and male gender and EBL ≥150 ml remained independent predictors of developing minor postoperative complications. Patients with postoperative complications would significantly experience longer hospital stay, later fluid intake, and delayed urinary catheter removal. Male, larger tumor volume, and more EBL were significant risk factors for laparoscopic colorectomy.
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30
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Choudhuri AH, Uppal R, Kumar M. Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: Audit from a tertiary care teaching institute. Int J Crit Illn Inj Sci 2014; 3:246-9. [PMID: 24459621 PMCID: PMC3891190 DOI: 10.4103/2229-5151.124117] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT The occurence of anastomotic leakage after gastointestinal resection and anastomosis is associated with significant mortality and morbidity. AIMS There is dearth of evidence in the literature on the influence of various non-surgical factors in causing anastomotic leakage although many studies have identified their possible role. MATERIALS AND METHODS A retrospective audit of all the anastomotic leakages occurring between September 2009 and April 2012 in our institute was performed to identify the potential non-surgical factors that can influence anastomotic leakage. A total of 137 out of 1246 patients who developed anastmotic leak were analyzed. All the potential non-surgical causes of anastomotic leakage available in the literature were analyzed by univariate analysis and stepwise multiple logistic regression analysis was done after adjusting for the type of surgery. An intergroup comparison among the patients based on the type of surgery was also performed. RESULTS THE FOLLOWING FACTORS WERE FOUND TO BE INDEPENDENTLY ASSOCIATED WITH INCREASED RISK OF ANASTOMOTIC LEAK: (1) albumin <3.5 g/dl, (2) anemia <8 g/dl, (3) hypotension (4) use of inotropes, and (5) blood transfusion. The majority of anastomotic leaks occurred after pancreatic surgeries followed by esophagectomies and occurred least after colonic resections. The risk for anastomotic leak was four times more in patients who required inotropic support in the perioperative period and three times more in patients who developed hypotension. CONCLUSIONS Our study is the first retrospective audit to identify the influence of non-surgical factors for anastomotic leakage and the need for further observational studies in this direction.
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Affiliation(s)
| | - Rajeev Uppal
- Department of Anesthesiology and Intensive Care, GB Pant Hospital, New Delhi, India
| | - Mritunjay Kumar
- Department of Anesthesiology and Intensive Care, GB Pant Hospital, New Delhi, India
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Choudhuri AH, Uppal R. Predictors of septic shock following anastomotic leak after major gastrointestinal surgery: An audit from a tertiary care institute. Indian J Crit Care Med 2013; 17:298-303. [PMID: 24339642 PMCID: PMC3841493 DOI: 10.4103/0972-5229.120322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Anastomotic leak is a serious complication after major gastrointestinal surgery and majority of deaths occur due to septic shock. Therefore, the early identification of risk factors of septic shock may help reduce the adverse outcomes. Objective: The aim of this audit was to determine the predictors of septic shock in patients with anastomotic leak after major gastrointestinal surgery. Design: Retrospective, audit. Materials and Methods: The patients admitted in the gastrosurgical intensive care unit ICU) of our institute between September 2009 and April 2012 with anastomotic leakage after surgery were identified. The ICU charts were retrieved from the database to identify the patients progressing to septic shock. A comparison of risk factors was made between the patients who developed septic shock (septic shock group) against the patients who did not (non-septic shock group). Results: The study sample comprised of 103 patients with anastomotic leak, of which 72 patients developed septic shock. The septic shock group had a higher APACHE II score, lower MAP, and higher HR at the time of ICU admission. They received greater transfusion of packed red blood cells during their ICU stay. Septic shock was more common after pancreaticojejunostomy and hepaticojejunostomy leaks. Conclusion: Presence of malignancy, chronic obstructive pulmonary disease (COPD), packed red blood cell transfusion, bacteremia, and hepaticojejunostomy or pancreaticojejunostomy leaks were independent predictors of mortality and length of ICU stay. To the best of our knowledge there are no available studies in the literature on the predictors of risk factors of septic shock in patients with anastomotic leakage.
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Affiliation(s)
- Anirban Hom Choudhuri
- Department of Anesthesiology and Intensive Care, Govind Ballabh Pant Hospital, New Delhi, India
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32
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Kornmann VNN, van Werkum MH, Bollen TL, van Ramshorst B, Boerma D. Compromised visceral circulation does not affect the outcome of colorectal surgery. Surg Today 2013; 44:1220-6. [PMID: 24081725 DOI: 10.1007/s00595-013-0730-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 06/04/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Anastomotic leakage is a serious complication after colorectal surgery, and many risk factors for this problem have so far been identified. The aim of this study was to assess the association between visceral arterial occlusive disease and anastomotic leakage. METHODS The preoperative abdominal computed tomography scans from all consecutive patients who underwent colorectal surgery with anastomosis in 2010 were retrospectively analyzed. RESULTS A total of 242 patients were included, with a median age of 65 years (interquartile range 55-74). Anastomotic leakage occurred in 14 % of cases (n = 34). The mortality rate was 3 % (n = 8). There was no association between atherosclerosis of the visceral or iliac arteries and anastomotic leakage. There was also no association between right-sided or left-sided resections and total occlusion of the superior or inferior mesenteric artery, respectively. CONCLUSION Asymptomatic visceral artery occlusive disease is not a risk factor for anastomotic leakage after colorectal surgery, and additional radiological imaging or percutaneous transluminal angioplasty for occluded visceral vessels is not indicated prior to colorectal surgery.
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Affiliation(s)
- Verena N N Kornmann
- Department of Surgery and Vascular Surgery, St. Antonius Hospital, 3435 CM, Nieuwegein, The Netherlands,
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