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Costa G, Frezza B, Fransvea P, Massa G, Ferri M, Mercantini P, Balducci G, Buondonno A, Rocca A, Ceccarelli G. Clinico-pathological Features of Colon Cancer Patients Undergoing Emergency Surgery: A Comparison Between Elderly and Non-elderly Patients. Open Med (Wars) 2019; 14:726-734. [PMID: 31637303 PMCID: PMC6778396 DOI: 10.1515/med-2019-0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Colorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery. Method We retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant'Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality. Results Of a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tumor site between the two groups. Comorbidities were significantly higher in elderly patients (73.4% vs 41.4%, p<0.001). No significant differences were observed between the two groups in surgical approach and the rate of one-stage procedures. Elderly patients were more frequently treated by Hartmann's procedure compared to non-elderly patients (20.2% vs 6.9%). Left colorectal resection with protective ileostomy was most frequent in the non-elderly group (27.6% vs 11.7%). No significant differences were found in the pT and pN categories of the TNM system between the two groups. However, a higher number of T3 in non-elderly patients was observed. A consistent number of non-oncologically adequate resections were observed in the elderly (21.3% vs 3.5%; p<0.03). The morbidity rate was significantly higher in the elderly group (31.9 % vs 3.4%, p<0.001). No significant difference was found in the mortality rate between the two groups, being 13.8% in the elderly and 6.9% in the non-elderly. Conclusions Emergency colorectal surgery for cancer still presents significant morbidity and mortality rates, especially in elderly patients. More aggressive tumors and advanced stages were more frequent in the non-elderly group and as a matter it should be taken into account when treating such patients in the emergency setting in order to perform a radical procedure as much as possible.
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Affiliation(s)
- Gianluca Costa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Barbara Frezza
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy.,Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
| | - Pietro Fransvea
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Giulia Massa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Antonio Buondonno
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
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Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock 2016; 43:212-21. [PMID: 25423128 DOI: 10.1097/shk.0000000000000305] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Procalcitonin (PCT) is an acute-phase reactant that has been used to diagnose and potentially track the treatment of sepsis. Procalcitonin values rise initially as the infection sets in and eventually fall with resolution. Its level has been reported to be significantly higher in potential nonsurvivors of a septic episode than among survivors. However, there is also a significant amount of evidence against this. We thus conducted a meta-analysis to pool data from all the available studies regarding PCT levels in survivors and nonsurvivors of sepsis. An extensive literature search was conducted using the key words "procalcitonin," "sepsis," and "prognosis." The references of the relevant studies were also scanned. The data from the eligible studies were extracted and analyzed for any significant pooled mean difference between survivors and nonsurvivors both on days 1 and 3. The mean difference in the day 1 PCT values between survivors and nonsurvivors was found to be statistically significant (P = 0.02). The mean difference on day 3 was also statistically significant (P = 0.002). However, in a subgroup consisting of studies on patients with severe sepsis and septic shock, day 1 difference was not found to be significant (P = 0.62). We found heterogeneity of 90% in our study population, which decreased to 62% after exclusion of studies conducted in emergency department patients. Procalcitonin levels in early stages of sepsis are significantly lower among survivors as compared with nonsurvivors of sepsis.
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Durnaś B, Wątek M, Wollny T, Niemirowicz K, Marzec M, Bucki R, Góźdź S. Utility of blood procalcitonin concentration in the management of cancer patients with infections. Onco Targets Ther 2016; 9:469-75. [PMID: 26858528 PMCID: PMC4731001 DOI: 10.2147/ott.s95600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diagnosis of infections in cancer patients is usually problematic since differentiating between infection and fever of unknown origin is often a considerable clinical challenge. In general, increase concentration of blood procalcitonin (PCT) is associated with severe bacterial infection. PCT with an optimal cutoff level of 0.5 ng/mL seems to be the most helpful biochemical parameter in detecting severe infections, mainly bloodstream infection, in patients with hematological cancers. In all clinical situations, the elevated level of PCT should be carefully analyzed, always with a thorough physical examination and an appropriate microbiological assessment.
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Affiliation(s)
- Bonita Durnaś
- Holy Cross Oncology Center of Kielce, Artwińskiego, Kielce, Poland; Department of Physiology, Pathophysiology and Microbiology of Infections, The Faculty of Health Sciences of the Jan Kochanowski University in Kielce, Aleja IX Wieków Kielc, Kielce, Poland
| | - Marzena Wątek
- Holy Cross Oncology Center of Kielce, Artwińskiego, Kielce, Poland
| | - Tomasz Wollny
- Holy Cross Oncology Center of Kielce, Artwińskiego, Kielce, Poland
| | - Katarzyna Niemirowicz
- Department of Microbiological and Nanobiomedical Engineering, Medical University of Bialystok, Bialystok, Poland
| | - Michał Marzec
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Bucki
- Department of Physiology, Pathophysiology and Microbiology of Infections, The Faculty of Health Sciences of the Jan Kochanowski University in Kielce, Aleja IX Wieków Kielc, Kielce, Poland; Department of Microbiological and Nanobiomedical Engineering, Medical University of Bialystok, Bialystok, Poland
| | - Stanisław Góźdź
- Holy Cross Oncology Center of Kielce, Artwińskiego, Kielce, Poland
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