Post-operative complications after colorectal cancer surgery increased with higher BMI

INTRODUCTION

Because of conflicting evidence regarding overweight and post-operative complications, this study focused on post-operative complications and death within 30 and 90 days after curatively intended surgery for colorectal cancer and its association with BMI.

METHODS

The study included all patients who had potentially curative surgery for colon or rectum cancer in Denmark from 2014 through 2018. The primary endpoint was post-operative complications within 30 days of surgery and secondary endpoints were 30- and 90-day mortality. All clinically relevant confounders were included in a multivariate analysis.

RESULTS

The cohort included 14,004 patients. In the multivariate logistic regression analysis, adjusting for relevant confounders, we found the odds ratio of having a surgical complication or having both a surgical and medical complication at the same time to be rising with increasing weight class. The multivariate analysis showed the odds ratio for both 30- and 90-day mortality to be higher for underweight patients and for obesity class III patients, but the rest of the patients had no significant differences in relative risk compared with normal-weight patients.

CONCLUSION

Based on our results, the risk of post-operative complications rises with increasing weight, whereas post-operative morbidity is increased only in the underweight and morbidly obese patients.

FUNDING

none.

TRIAL REGISTRATION

The study was approved by the Danish Data Protection Agency (REG-008-2020).

IMPACT OF SCREENING ON SHORT-TERM MORTALITY AND MORBIDITY FOLLOWING TREATMENT FOR COLORECTAL CANCER

BACKGROUND AND AIMS

The aim of this study was to describe short-term changes in morbidity and mortality associated with the implementation of screening for colorectal cancer in Denmark.

MATERIALS AND METHODS

Prospective cohort study with inclusion of all patients aged 50-75 years treated for colorectal cancer between 1 March 2014 and 31 December 2015 in Denmark. Adjusted hazard ratios were calculated for 30 and 90 days mortality using Cox Regression. We made two adjusted models-a "basic" adjusted for screening status, sex, age, smoking, alcohol consumption, and cancer type and an "advanced" that also included body mass index and American society of Anesthesiologists score in analyses. Relative risks were calculated for postoperative surgical and medical complications.

RESULTS

In total, 5348 patients were included. In the "basic model," adjusted risk of 30 and 90 days total mortality was reduced in the screen-detected group (p < 0.01, HR = 0.43, CI = 0.24-0.76) and (p < 0.01, HR = 0.45, CI = 0.30-0.69). In the "advanced model," only 90 days total mortality was significantly reduced in the screen-detected group (p = 0.01, HR 0.59, CI = 0.39-0.90). No significant changes were found with regard to surgical and medical complications, respectively, (p = 0.05 (CI = 0.76-1.00) and p = 0.47(CI = 0.74-1.15)).

CONCLUSION

This nationwide study showed that screening for colorectal cancer was associated with a lower 90 days total mortality although no significant improvements were seen with regard to morbidity.

Three years of colorectal cancer screening in Denmark

BACKGROUND

The Danish National Colorectal Cancer Screening Programme was implemented in March 2014 and is offered free of charge to all residents aged 50-74 years. The aim of this study is to compare performance indicators from the Danish National Colorectal Cancer Screening Programme to the recommendations from European Guidelines in order to assure the quality of the programme and to provide findings relevant to other population-based colorectal cancer screening programmes.

METHODS

Based on data from the Danish Colorectal Cancer Screening Database, we evaluated all performance indicators for which the European Guidelines provided acceptable level, desirable level or the level from first screening rounds in population-based studies using FIT.

RESULTS

All performance indicators were above the acceptable level and/or in line with the level from the first screening round in population-based studies using FIT. Whenever the European Guidelines provided a desirable level for a performance indicator, the Danish National Colorectal Cancer Screening Programme was close to or above this desirable level.

CONCLUSIONS

Compared to the European Guidelines, all performance indicators were above the acceptable level and close to the desirable level. Based on these findings, the implementation of the National Danish Colorectal Cancer Screening Programme is considered a success and the programme is hopefully in the process of reducing colorectal cancer morbidity and mortality in Denmark. This study provides relevant information for comparisons to other population-based public service colorectal cancer screening programmes as well as for future revisions of guidelines.

A high lymph node yield in colon cancer is associated with age, tumour stage, tumour sub-site and priority of surgery. Results from a prospective national cohort study

AIM

To determine the relation between patient-related and histopathological factors, as well as the influence of national programs for diagnosing and treatment of colon cancer and a lymph node yield (LNY) ≥ 12.

METHOD

An analysis was carried out of the LNY in a nationwide Danish cohort treated by curative resection of stage I-III colon cancer in the period 2003-2011. The association between a LNY ≥ 12 and age, sex, body mass index, open vs. laparoscopic surgery, acute vs. elective surgery, pT stage, tumour sub-site and year of diagnosis was analysed.

RESULTS

A total of 13,766 patients were eligible for the analysis. In total, 71.4 % of the patients had a LNY ≥ 12. In multivariate analysis, age, pT stage, tumour sub-site and priority of surgery were independently associated with the probability of a LNY ≥ 12. Odds ratios (ORs) were as follows: age <65 1, 65-75 0.685 (confidence interval (CI) 0.586-0.800), >75 0.517 (CI 0.439-0.609); T1 1, T2 2.750 (CI 2.168-3.487), T3 6.016 (CI 4.879-7.418), T4 6.317 (CI 4.950-8.063); right colon 1, left colon 0.568 (0.511-0.633); elective surgery 1, acute surgery 0.748 (CI 0.625-0.894). Moreover, year of diagnosis was associated with the probability of a LNY ≥ 12: OR 1.480 (CI 1.445-1.516) for each increasing year in the study period.

CONCLUSION

A LNY ≥ 12 is significantly associated with age, pT stage, tumour sub-site and priority of surgery. A significant increase in the LNY over the period of the study was observed, probably reflecting the effect of national programmes initiated by the Danish Colorectal Cancer Group.

Elderly patients with colorectal cancer are oncologically undertreated

AIMS

Colorectal cancer (CRC) is mainly a disease of the elderly. Our primary aim was to investigate if age had influence on treatment decisions in regards to surgery, referral to an oncologist and treatment by an oncologist.

METHOD

We identified patients with CRC in our department from 2004 through 2011 in the Danish Colorectal Cancer Group (DCCG) database. According to age ≤75 and >75 years multivariate logistic regression analysis was used on treatment decisions: surgery, referral to an oncologist and oncologic treatment. Independent variables were age, ASA score, tumorlocation, stage, gender and year of diagnosis. Additional analysis was performed for stage III and IV patients as a subgroup.

RESULTS

1701 patients were included of which 525 were >75 years of age. In multivariate analysis there was no association between age and chance of surgery. Older patients had a significantly lower odds ratio for referral to an oncologist (OR 0.624, p < 0.0001) and for oncological treatment if referred (OR 0.218, p < 0.0001). Being an elderly patient with stage III or IV CRC OR was 0.233 for referral- and for receiving treatment by an oncologist OR was 0.210 (p < 0.0001 for both), after adjusting for possible confounders.

CONCLUSION

Based on age elderly patients are on a lesser extent referred to an oncologist and get oncologic treatment less frequently. Surgically the elderly are not undertreated.

The majority of surgical departments adhere to national Danish guidelines for surveillance after colorectal cancer surgery

INTRODUCTION

In 2003 the use of post-operative surveillance (POS) after surgery for colorectal cancer (CRC) in Denmark was studied. Diversity in the choice and frequency of surveillance modalities was found. Subsequently, the Danish Colorectal Cancer Group (DCCG) has published guidelines for POS. In the same period, the number of departments performing CRC surgery has been reduced by 50% nationally. The aim of the present study was to describe the POS after CRC in Denmark following a reduction in the number of departments performing operations for CRC and the DCCG's publication of national recommendations for POS programmes.

MATERIAL AND METHODS

Questionnaires were sent to all 19 departments that performed operations for CRC. Questions concerned the diagnostic modalities used for detecting recurrences and metachrone cancers.

RESULTS

All departments returned their questionnaires. All departments had a formal POS programme. The recommendations given by the DCCG were met by 17 departments (89%) with regard to liver metastases, by 16 departments (84%) with regard to lung metastases and by 16 departments (84%) with regard to metachrone cancers.

CONCLUSION

As opposed to what was observed in 2003, all departments offered a POS programme after CRC surgery in 2012. Almost all departments met the DCCG recommendations, probably owing to the centralization of CRC surgery and the DCCG's introduction of national guidelines. Hopefully, this will contribute to a better survival for CRC patients in the future, although more research is needed to establish optimal post-operative surveillance.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

Increased levels of C-reactive protein and leukocyte count are poor predictors of anastomotic leakage following laparoscopic colorectal resection

INTRODUCTION

Laparoscopic procedure and fast-track regimen with short post-operative hospital stay are gaining ground in colorectal surgery. The aim of the present study was to determine whether the levels of C-reactive protein (CRP) and white blood cell counts (WBC) have a role as early predictors of post-operative septic complications including anastomotic leakage in patients operated laparoscopically in a fast-track regimen.

MATERIAL AND METHODS

This was a retrospective analysis of 129 patients who underwent laparoscopic colorectal surgery in a fast-track regimen during a one-year period. The levels of CRP and WBC were measured daily until discharge. The diagnostic accuracy was evaluated using the receiver-operating characteristics methodology.

RESULTS

The median post-operative hospital stay was three days. Septic complications occurred in 32% of cases. Post-operative CRP level was significantly higher in patients with septic complications than in patients without complications, but similar in patients with anastomotic leakage and patients with other septic complications. The best cut-off value for CRP level as a predictor of septic complications was observed on post-operative day (POD) 3, where CRP concentration > 200 mg/l had a sensitivity of 68% and a specificity of 74%. WBC measurements showed the best cut-off value on POD 2, where WBC > 12 × 10(9) had a sensitivity of 90% and a specificity of 62%.

CONCLUSION

The insufficient diagnostic accuracy of the levels of CRP and WBC made them weak diagnostic markers in prediction of post-operative septic complications, including anastomotic leakage, in the first three post-operative days after laparoscopic colorectal surgery.