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Le Quang AT, Carli F, Prince F. Is preoperative physical function testing predictive of length of stay in patients with colorectal cancer? A retrospective study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106956. [PMID: 37414630 DOI: 10.1016/j.ejso.2023.06.008] [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: 03/03/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Surgery is the primary treatment for colorectal cancer. A prolonged Length of Stay (pLOS) can increase risk of complications and physical inactivity, leading to a decline in physical function. While promising results were seen from preoperative exercise training and post-operative functional recovery, the predictive potential of preoperative physical function has not yet been investigated. The objective of this study is to determine if preoperative physical function can predict pLOS in patients with colorectal cancer. A total of 459 patients from 7 cohorts were analyzed. Logistic regression was used to determine risk of pLOS (>3 days), and ROC curve was plotted to establish sensitivity/specificity. Selected variables included age, sex, BMI, comorbidity, ASA status, tumor site, surgical approach, handgrip strength, Timed-Up and Go, 30-s Sit-to-Stand, 30-s Arm Curl Test, 6-Minute-Walking Test (6MWT), CHAMPS Physical Activity Questionnaire for Older Adult and the 36-Item Short Form Survey. The results showed that patients with rectal tumor are 2.7x more at risk to be in the pLOS group compared to those with colon tumor (O.R. 2.7; C.I. 1.3-5.7, p=0.01). For every increment of 20 m in 6MWT, there is a decreased risk of 9% of being in pLOS group (C.I. 1.03-1.17, p=0.00). A cut-off of 431 m can predict 70% of patients in pLOS group (AUC 0.71 C.I 0.63-0.78, p=0.00). Tumor site (rectal) and 6MWT were significant predictors of pLOS. Using the 6MWT as a screening tool for pLOS with cut-off of 431 m should be implemented in the preoperative surgical pathway.
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Affiliation(s)
- A T Le Quang
- Département de chirurgie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | - F Prince
- Département de chirurgie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
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Tagerman DL, Ramos-Santillan V, Kalam A, Wang F, Schriner JB, Arientyl V, Solsky I, Friedmann P, Abdelnaby A, In H. Potentially Avoidable Admissions and Prolonged Hospitalization in Patients with Suspected Colon Cancer. Ann Surg Oncol 2023; 30:4748-4758. [PMID: 37198337 DOI: 10.1245/s10434-023-13593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Suspicion of cancer in the Emergency Department (ED) may lead to potentially avoidable and prolonged admissions. We aimed to examine the reasons for potentially avoidable and prolonged hospitalizations after admissions from the ED for new colon cancer diagnoses (ED-dx). METHODS A retrospective, single-institution analysis was conducted of patients with ED-dx between 2017 and 2018. Defined criteria were used to identify potentially avoidable admissions. Patients without avoidable admissions were examined for ideal length of stay (iLOS), using separate defined criteria. Prolonged length of stay (pLOS) was defined as actual length of stay (aLOS) being greater than 1 day longer than iLOS. RESULTS Of 97 patients with ED-dx, 12% had potentially avoidable admissions, most often (58%) for cancer workup. Very little difference in demographic, tumor characteristics, or symptoms were found, except patients with potentially avoidable admissions were more functional (Eastern Cooperative Oncology Group [ECOG] score 0-1: 83% vs. 46%; p = 0.049) and had longer symptom duration prior to ED presentation {24 days (interquartile range [IQR] 7-75) vs. 7 days (IQR 2-21)}. Among the 60 patients who had necessary admissions but did not require urgent intervention, 78% had pLOS, most often for non-urgent surgery (60%) and further oncologic workup. The median difference between iLOS and aLOS was 12 days (IQR 8-16) for pLOS. CONCLUSIONS Potentially avoidable admissions following Ed-dx were uncommon but were mostly for oncologic workup. Once admitted, the majority of patients had pLOS, most often for definitive surgery and further oncologic workup. This suggests a lack of systems to safely transition to outpatient cancer management.
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Affiliation(s)
- Daniel L Tagerman
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vicente Ramos-Santillan
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ali Kalam
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fei Wang
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob B Schriner
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vanessa Arientyl
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ian Solsky
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Surgical Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - Patricia Friedmann
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Abier Abdelnaby
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Emland F, Taflin H, Carlsson G, Ljungman D, Lindskog EB. Prolonged postoperative length of stay may be a valuable marker for susceptibility to relapse beyond established risk factors in patients with stage III colon cancer. World J Surg Oncol 2022; 20:277. [PMID: 36056361 PMCID: PMC9438186 DOI: 10.1186/s12957-022-02742-8] [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: 06/10/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Delay from surgery to adjuvant chemotherapy causes impaired survival among patients undergoing radical resection for stage III colon cancer, and the underlying mechanism for this is incompletely clarified. It is established that prolonged postoperative hospital length of stay (LOS) is associated with delayed initiation of the adjuvant treatment driving the assumption that prolonged LOS is prognostically unfavorable due to this fact and case mix factors. We hypothesize that prolonged LOS after surgery is a valuable marker for susceptibility to relapse that is not detected in established prognostic factors and, alone, associated with a shorter disease-free survival (DFS). Materials and methods A total of 690 consecutive patients undergoing elective radical resection for stage III colon cancer in 2000–2015 were identified in a prospective detailed facility database. Univariate and multivariate analyses were performed using Cox proportional hazards model in the evaluation of LOS as an independent prognostic factor. Results Short postoperative LOS, low comorbidity, and few complications were associated with longer DFS (p < 0.01). Fewer patients in the short and intermediate LOS groups had a relapse in their disease (28% and 33%, respectively), compared to the patients with longer LOS (40%, p < 0.05). LOS was a prognostic factor for DFS in the unadjusted univariate model (HR 1.04 per unit change) and remained statistically significant in the adjusted multivariate analysis, with a HR of 1.03 per hospital day (p < 0.01). Conclusions Postoperative LOS independently correlates with the risk of recurrence and DFS, regardless of if adjuvant chemotherapy is given, along with the factors such as age, comorbidity, complications, and tumor features. We propose a further investigation into the causal mechanisms based on tumor and host biology linking LOS to DFS beyond established risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02742-8.
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Affiliation(s)
- Frans Emland
- Sahlgrenska Academy at University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden
| | - Helena Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Transplant Centre, University of Gothenburg, Gothenburg, Sweden
| | - Göran Carlsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden
| | - Elinor Bexe Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.
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Guidolin K, Withers R, Shariff F, Ashamalla S, Nadler A. Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery. ACTA ACUST UNITED AC 2021; 28:2079-2086. [PMID: 34204959 PMCID: PMC8293034 DOI: 10.3390/curroncol28030192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022]
Abstract
Thirty percent of colon cancer diagnoses occur following emergency presentations, often with bowel obstruction or perforation requiring urgent surgery. We sought to compare cancer care quality between patients receiving emergency versus elective surgery. We conducted an institutional retrospective matched (46 elective:23 emergency; n = 69) case control study. Patients who underwent a colon cancer resection from January 2017 to February 2019 were matched by age, sex, and cancer stage. Data were collected through the National Surgical Quality Improvement Program and chart review. Process outcomes of interest included receipt of cross-sectional imaging, CEA testing, pre-operative cancer diagnosis, pre-operative colonoscopy, margin status, nodal yield, pathology reporting, and oncology referral. No differences were found between elective and emergency groups with respect to demographics, margin status, nodal yield, oncology referral times/rates, or time to pathology reporting. Patients undergoing emergency surgery were less likely to have CEA levels, CT staging, and colonoscopy (p = 0.004, p = 0.017, p < 0.001). Emergency cases were less likely to be approached laparoscopically (p = 0.03), and patients had a longer length of stay (p < 0.001) and 30-day readmission rate (p = 0.01). Patients undergoing emergency surgery receive high quality resections and timely post-operative referrals but receive inferior peri-operative workup. The adoption of a hybrid acute care surgery model including short-interval follow-up with a surgical oncologist or colorectal surgeon may improve the quality of care that patients with colon cancer receive after acute presentations. Surgeons treating patients with colon cancer emergently can improve their care quality by ensuring that appropriate and timely disease evaluation is completed.
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Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada; (K.G.); (F.S.); (S.A.)
| | - Rebecca Withers
- Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Farhana Shariff
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada; (K.G.); (F.S.); (S.A.)
| | - Shady Ashamalla
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada; (K.G.); (F.S.); (S.A.)
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Ashlie Nadler
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada; (K.G.); (F.S.); (S.A.)
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Correspondence:
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In response to the director letter "Polyphenols, Mediterranean diet, and colon cancer". Support Care Cancer 2019; 27:4037. [PMID: 31468194 DOI: 10.1007/s00520-019-05011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
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Polyphenols, Mediterranean diet, and colon cancer. Support Care Cancer 2019; 27:4035-4036. [DOI: 10.1007/s00520-019-04835-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
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