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Ohkuma M, Takano Y, Goto K, Okamoto A, Koyama M, Abe T, Nakano T, Takeda Y, Kosuge M, Eto K. Significance of Naples prognostic score for postoperative complications after colorectal cancer surgery. Surg Today 2025:10.1007/s00595-025-03055-5. [PMID: 40332592 DOI: 10.1007/s00595-025-03055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 04/22/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE The Naples prognostic score (NPS) is a sensitive scoring system that reflects both inflammatory and nutritional status. This study examined the significance of NPS in predicting postoperative complications following colorectal cancer surgery. METHODS The present study included data from 443 patients who underwent curative resection for colorectal cancer. The patients were classified into low NPS (score 0-2) and high NPS (score 3-4) groups. We retrospectively investigated the relationship between NPS and postoperative complications (Clavien-Dindo classification ≥ II). RESULTS Among all patients, 57 (13%) developed postoperative complications. A total of 340 patients (77%) were categorized into the low NPS group and 103 (23%) were categorized into the high NPS group. A multivariate analysis identified that high NPS (P < 0.001), tumor location in the rectum (P = 0.025), longer operation time (P = 0.027), and greater blood loss (P = 0.004) were independent risk factors for postoperative complications. Furthermore, high NPS was significantly associated with older age (P < 0.001), higher American Society of Anesthesiologists physical status score (P = 0.029), advanced T stage (P < 0.001), N stage (P = 0.036), and longer length of hospital stay (P < 0.010). CONCLUSIONS NPS is a strong predictor of poor outcomes in patients undergoing curative resection for colorectal cancer, suggesting the importance of systemic inflammation and the nutritional status.
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Affiliation(s)
- Masahisa Ohkuma
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuhiro Takano
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Keisuke Goto
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Atsuko Okamoto
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Muneyuki Koyama
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tadashi Abe
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takafumi Nakano
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuhiro Takeda
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Makoto Kosuge
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicinee, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Trillsch F, Czogalla B, Mahner S, Loidl V, Reuss A, du Bois A, Sehouli J, Raspagliesi F, Meier W, Cibula D, Mustea A, Runnebaum IB, Schmalfeldt B, Aletti G, Kimmig R, Scambia G, Hilpert F, Hasenburg A, Wagner U, Harter P. Risk factors for anastomotic leakage and its impact on survival outcomes in radical multivisceral surgery for advanced ovarian cancer: an AGO-OVAR.OP3/LION exploratory analysis. Int J Surg 2025; 111:2914-2922. [PMID: 39992106 DOI: 10.1097/js9.0000000000002306] [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] [Received: 11/30/2024] [Accepted: 01/31/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Anastomotic leakage is a significant complication following bowel resection in cytoreductive surgery for ovarian cancer. Previous studies have highlighted the detrimental effects of anastomotic leakage on patients' postoperative course. However, there is still a lack of precise identification of the high-risk population and established strategies for preventing its occurrence. MATERIALS AND METHODS Patients who underwent bowel resection within the surgical phase III trial AGO-OVAR.OP3/LION investigating the impact of systematic pelvic and paraaortic lymphadenectomy in cytoreductive surgery for primary ovarian cancer were included in this analysis. All patients in the AGO-OVAR.OP3/LION trial had undergone complete cytoreduction with no macroscopic residual disease. We analyzed the occurrence of anastomotic leakage regarding surgical procedure (non-lymphadenectomy vs. lymphadenectomy and non-stoma vs. stoma) using the Fisher test. Risk factors for anastomotic leakage and its prognostic impact on survival were analyzed. RESULTS Overall rate of anastomotic leakage was 7.1%. Notably, the Non-lymphadenectomy subgroup had a lower anastomotic leakage rate of 3.0% compared to the lymphadenectomy subgroup (11.2%, P = 0.005). The use of protective stoma placement resulted in an anastomotic leakage rate of 5.5% regardless of lymphadenectomy compared to the Non-Stoma subgroup (7.5%, P = 0.78). Increased blood loss (odds ratio [OR] 1.04 per 100cc, 95% confidence interval [CI] 1.0001-1.09) and lymphadenectomy (OR 3.67, 95% CI 1.41-11.40) were associated with a higher risk of anastomotic leakage. Although anastomotic leakage demonstrated a numerical detrimental impact on median progression-free survival (PFS) (18 months with anastomotic leakage vs. 19 months with Non-anastomotic leakage, hazard ratio [HR] 0.86; 95% CI 0.5 to 1.4, P = 0.53) and median overall survival (OS) (31 months with anastomotic leakage vs. 58 months with Non-anastomotic leakage, HR 0.69; 95% CI 0.4 to 1.2, P = 0.17), the differences were not statistically significant. CONCLUSION Anastomotic leakage rates were lower in the Non-lymphadenectomy arm, the current standard of care. Blood loss and lymphadenectomy, as surrogate markers for extensive surgery, were associated with increased risk for anastomotic leakage. These findings highlight the importance of strategies to reduce surgical complexity and perioperative risk to improve clinical outcomes.
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Affiliation(s)
- Fabian Trillsch
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Verena Loidl
- Faculty of Medicine, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
| | - Alexander Reuss
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Werner Meier
- Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Germany
| | - David Cibula
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Czech Republic
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine and Center for Gynecologic Oncology, Jena University Hospital, Jena, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giovanni Aletti
- Department of Gynecologic Oncology, European Institute of Oncology, University of Milan, Italy
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del S. Cuore Rome, Rome, Italy
| | - Felix Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Annette Hasenburg
- University Medical Center Mainz, Department of Gynecology and Obstetrics, Mainz, Germany
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University Hospital Giessen and Marburg, Marburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology and Obstetrics, University Hospital Giessen and Marburg, Marburg, Germany
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Scheurer F, Kaiser D, Kobe A, Smolle M, Suter D, Spirig JM, Müller D. The effect of preoperative embolization on giant cell tumors of the bone localized in the iliosacral region of the pelvis. Surg Oncol 2024; 55:102101. [PMID: 39018867 DOI: 10.1016/j.suronc.2024.102101] [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] [Received: 02/27/2024] [Revised: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. METHODS Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. RESULTS Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. CONCLUSION Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.
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Affiliation(s)
- Fabrice Scheurer
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland.
| | - Dominik Kaiser
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Adrian Kobe
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Maria Smolle
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Suter
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - José Miguel Spirig
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Müller
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
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Rudzki J, Polewka M, Agopsowicz P, Nowak A, Porada M, Czempik PF. Current approach to the management of preoperative iron deficiency anemia in colorectal cancer patients: a review of literature. POLISH JOURNAL OF SURGERY 2024; 96:67-74. [PMID: 39138992 DOI: 10.5604/01.3001.0054.5124] [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: 08/15/2024]
Abstract
<b>Introduction:</b> The prevalence of preoperative anemia is the highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (ID). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. ABT is itself associated with increased morbidity and mortality.<b>Aim:</b> The aim of this review article was to present the pathophysiology and the current approach to the diagnostics and treatment of preoperative iron deficiency anemia (IDA) in CRC patients.<b>Material and methods:</b> Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: CRC, colorectal surgery, ID, IDA, intravenous iron, Patient Blood Management (PBM).<b>Results:</b> There are several laboratory parameters that can be used for IDA diagnosis, however, the simplest and most cost- -effective is reticulocyte hemoglobin equivalent (RET-He). Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as opposed to oral, iron formulations. Applying PBM strategies minimizes the exposure to ABT.<b>Conclusions:</b> Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore, preoperative IDA in CRC patients needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. ABT should be the treatment of last resort due to the risk of negative clinical consequences, including an increased rate of cancer recurrence.
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Affiliation(s)
- Jakub Rudzki
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Polewka
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Paulina Agopsowicz
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Nowak
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Porada
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr F Czempik
- Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland, Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland
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Ali D, Syed M, Gamboa AC, Hawkins AT, Regenbogen SE, Holder-Murray J, Silviera M, Ejaz A, Balch GC, Khan A. Association of omental pedicled flap with anastomotic leak following low anterior resection for rectal cancer. J Surg Oncol 2024; 129:930-938. [PMID: 38167808 DOI: 10.1002/jso.27572] [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] [Received: 10/27/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Anastomotic leak following colorectal anastomosis adversely impacts short-term, oncologic, and quality-of-life outcomes. This study aimed to assess the impact of omental pedicled flap (OPF) on anastomotic leak among patients undergoing low anastomotic resection (LAR) for rectal cancer using a multi-institutional database. METHODS Adult rectal cancer patients in the US Rectal Cancer Consortium, who underwent a LAR for stage I-III rectal cancer with or without an OPF were included. Patients with missing data for surgery type and OPF use were excluded from the analysis. The primary outcome was the development of anastomotic leaks. Multivariable logistic regression was used to determine the association. RESULTS A total of 853 patients met the inclusion criteria and OPF was used in 106 (12.4%) patients. There was no difference in age, sex, or tumor stage of patients who underwent OPF versus those who did not. OPF use was not associated with an anastomotic leak (p = 0.82), or operative blood loss (p = 0.54) but was associated with an increase in the operative duration [β = 21.42 (95% confidence interval = 1.16, 41.67) p = 0.04]. CONCLUSIONS Among patients undergoing LAR for rectal cancer, OPF use was associated with an increase in operative duration without any impact on the rate of anastomotic leak.
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Affiliation(s)
- Danish Ali
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Maria Syed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Alexander T Hawkins
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jennifer Holder-Murray
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Matthew Silviera
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Glen C Balch
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Aimal Khan
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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