1
|
Hajjar R, Richard C, Santos MM. The gut barrier as a gatekeeper in colorectal cancer treatment. Oncotarget 2024; 15:562-572. [PMID: 39145528 PMCID: PMC11325587 DOI: 10.18632/oncotarget.28634] [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: 08/16/2024] Open
Abstract
Colorectal cancer (CRC) is highly prevalent and is a major cause of cancer-related deaths worldwide. The incidence rate of CRC remains alarmingly high despite screening measures. The main curative treatment for CRC is a surgical resection of the diseased bowel segment. Postoperative complications usually involve a weakened gut barrier and a dissemination of bacterial proinflammatory lipopolysaccharides. Herein we discuss how gut microbiota and microbial metabolites regulate basal inflammation levels in the gut and the healing process of the bowel after surgery. We further elaborate on the restoration of the gut barrier function in patients with CRC and how this potentially impacts the dissemination and implantation of CRC cells in extracolonic tissues, contributing therefore to worse survival after surgery.
Collapse
Affiliation(s)
- Roy Hajjar
- Nutrition and Microbiome Laboratory, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Surgery, Digestive Surgery Service, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Institut du cancer de Montréal, Montréal, Québec, Canada
- Division of General Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Carole Richard
- Department of Surgery, Digestive Surgery Service, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Division of General Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Manuela M Santos
- Nutrition and Microbiome Laboratory, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Institut du cancer de Montréal, Montréal, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
2
|
Ailioaie RC, Stefanescu E, Leahu C, Boldis A, Scurtu R. The Influence of Analgesic Wound Infiltration on Postoperative Pain and Inflammatory Cytokines in Open Colorectal Surgery: A Randomized Comparative Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1244. [PMID: 39202525 PMCID: PMC11356478 DOI: 10.3390/medicina60081244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins.
Collapse
Affiliation(s)
- Raluca Cristina Ailioaie
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Elena Stefanescu
- Anesthesia and Intensive Care Department, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania; (E.S.); (C.L.); (A.B.)
| | - Crina Leahu
- Anesthesia and Intensive Care Department, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania; (E.S.); (C.L.); (A.B.)
| | - Alexandra Boldis
- Anesthesia and Intensive Care Department, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania; (E.S.); (C.L.); (A.B.)
| | - Razvan Scurtu
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| |
Collapse
|
3
|
Mattart L, Magotteaux P, Blétard N, Brescia L, Debergh N, De Meester C, Demolin G, Dister F, Focan C, Francart D, Godin S, Houbiers G, Jehaes C, Jehaes F, Namur G, Monami B, Verdin V, Weerts J, Witvrouw N, Markiewicz S. Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease. Acta Chir Belg 2024; 124:208-216. [PMID: 37964580 DOI: 10.1080/00015458.2023.2278238] [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: 11/30/2022] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.
Collapse
Affiliation(s)
- L Mattart
- Medical and business information, CHC Groupe Santé, Liège, Belgium
| | - P Magotteaux
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Blétard
- Department of pathology, CHC Groupe Santé, Liège, Belgium
| | - L Brescia
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Debergh
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - C De Meester
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - G Demolin
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
- Department of gastroenterology, CHC Groupe Santé, Liège, Belgium
| | - F Dister
- Department of imagery, CHC Groupe Santé, Liège, Belgium
| | - C Focan
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
| | - D Francart
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - S Godin
- Department of radiotherapy, CHU Liege, Liège, Belgium
| | - G Houbiers
- Department of oncoloy, CHC Groupe Santé, Liège, Belgium
- Department of gastroenterology, CHC Groupe Santé, Liège, Belgium
| | - C Jehaes
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - F Jehaes
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - G Namur
- Department of nuclear medicine, CHC Groupe Santé, Liège, Belgium
| | - B Monami
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - V Verdin
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - J Weerts
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| | - N Witvrouw
- Department of nuclear medicine, CHC Groupe Santé, Liège, Belgium
| | - S Markiewicz
- Department of abdominal surgery, CHC Groupe Santé, Liège, Belgium
| |
Collapse
|
4
|
Chiarello MM, Fico V, Brisinda G. Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes: a prospective non-randomized controlled trial. Updates Surg 2023; 75:2413-2415. [PMID: 37792274 DOI: 10.1007/s13304-023-01662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Azienda Sanitaria Provinciale Cosenza, 87100, Cosenza, Italy
| | - Valeria Fico
- Department of Medical and Surgical Sciences, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giuseppe Brisinda
- Department of Medical and Surgical Sciences, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Facoltà di Medicina e Chirurgia, Università Cattolica S Cuore, 00168, Rome, Italy.
| |
Collapse
|
5
|
Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg 2023; 15:745-756. [PMID: 37342854 PMCID: PMC10277951 DOI: 10.4240/wjgs.v15.i5.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. Despite significant improvements in surgical technique, postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery. The most feared complication is anastomotic leakage. It negatively affects short-term prognosis, with increased post-operative morbidity and mortality, higher hospitalization time and costs. Moreover, it may require further surgery with the creation of a permanent or temporary stoma. While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC, still under discussion is its impact on the long-term prognosis. Some authors have described an association between leakage and reduced overall survival, disease-free survival, and increased recurrence, while other Authors have found no real impact of dehiscence on long term prognosis. The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery. The main risk factors of leakage and early detection markers are also summarized.
Collapse
Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
| |
Collapse
|
6
|
Zizzo M, Morini A, Zanelli M, Tumiati D, Sanguedolce F, Palicelli A, Mereu F, Ascani S, Fabozzi M. Short-Term Outcomes in Patients Undergoing Virtual/Ghost Ileostomy or Defunctioning Ileostomy after Anterior Resection of the Rectum: A Meta-Analysis. J Clin Med 2023; 12:jcm12113607. [PMID: 37297802 DOI: 10.3390/jcm12113607] [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: 04/05/2023] [Revised: 05/02/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Anterior rectal resection (ARR) represents one of the most frequently performed methods in colorectal surgery, mainly carried out for rectal cancer (RC) treatment. Defunctioning ileostomy (DI) has long been chosen as a method to "protect" colorectal or coloanal anastomosis after ARR. However, DI does not rule out risks of more or less serious complications. A proximal intra-abdominal closed-loop ileostomy, the so-called virtual/ghost ileostomy (VI/GI), could limit the number of DIs and the associated morbidity. MATERIALS AND METHODS We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Meta-analysis was performed by use of RevMan [Computer program] Version 5.4. RESULTS The five included comparative studies (VI/GI or DI) covering an approximately 20-year study period (2008-2021). All included studies were observational ones and originated from European countries. Meta-analysis indicated VI/GI as significantly associated with lower short-term morbidity rates related to VI/GI or DI after primary surgery (RR: 0.21, 95% CI: 0.07-0.64, p = 0.006), fewer dehydration (RR: 0.17, 95% CI: 0.04-0.75, p = 0.02) and ileus episodes after primary surgery (RR: 0.20, 95% CI: 0.05-0.77, p = 0.02), fewer readmissions after primary surgery (RR: 0.17, 95% CI: 0.07-0.43, p = 0.0002) and readmissions after primary surgery plus stoma closure surgery (RR: 0.14, 95% CI: 0.06-0.30, p < 0.00001) than the DI group. On the contrary, no differences were identified in terms of AL after primary surgery, short-term morbidity after primary surgery, major complications (CD ≥ III) after primary surgery and length of hospital stay after primary surgery. Conclusions: Given the significant biases among meta-analyzed studies (small overall sample size and the small number of events analyzed, in particular), our results require careful interpretation. Further randomized, possibly multi-center trials may be of paramount importance in confirming our results.
Collapse
Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Morini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - David Tumiati
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federica Mereu
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Stefano Ascani
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, 06129 Perugia, Italy
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Massimiliano Fabozzi
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| |
Collapse
|
7
|
Brisinda G, Chiarello MM, Pepe G, Cariati M, Fico V, Mirco P, Bianchi V. Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors. World J Clin Cases 2022; 10:13321-13336. [PMID: 36683625 PMCID: PMC9850997 DOI: 10.12998/wjcc.v10.i36.13321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anastomotic leakage (AL) after restorative surgery for rectal cancer (RC) is associated with significant morbidity and mortality.
AIM To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.
METHODS To identify risk factors for AL, a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated.
RESULTS The incidence of AL was 10.4%, with a mean time interval of 6.2 ± 2.1 d. Overall mortality was 0.8%. Mortality was higher in patients with AL (4.9%) than in patients without leak (0.4%, P = 0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index < 40 points, tumor diameter and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to AL in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did.
CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of AL. It adversely affects the morbidity and mortality of RC patients.
Collapse
Affiliation(s)
- Giuseppe Brisinda
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Surgery, Università Cattolica S Cuore, Rome 00168, Italy
| | | | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Maria Cariati
- Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Crotone 88900, Italy
| | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Paolo Mirco
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| |
Collapse
|
8
|
Mathew AP, M S, K C, Muralee M, Wagh M. Morbidity of Temporary Loop Ileostomy in Patients with Colorectal Cancer. Indian J Surg Oncol 2022; 13:468-473. [PMID: 36187539 PMCID: PMC9515269 DOI: 10.1007/s13193-022-01501-1] [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: 07/20/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
Leakage of low colorectal anastomoses after total mesorectal excision is a dreaded complication. Hence, an ileostomy is commonly performed during anterior resection especially in patients who have received neoadjuvant radiation. The aim of this study was to quantify the temporary loop ileostomy-related benefits as well as morbidity in patients with colorectal cancer. We did a retrospective study including all patients who underwent anterior resection with diversion ileostomy for biopsy-proven rectal carcinoma at our institute from 1 Jan 2016 to 31 Dec 2017 with follow-up of 2 years. A total of 104 patients were included in the study. In our series, 6.7% patients had an anastomotic dehiscence which precluded patients from stoma reversal. 12.5% of the patients had a stoma-related complication. 5.7% patients had complications following a stoma reversal. Eighty percent of the patients who developed clinically evident dehiscence in the immediate postoperative period were managed conservatively because of the presence of stoma. We did not have any mortality related to the stoma. 18.3% patients did not have their stomas reversed. The stoma non-reversal due to anastomotic dehiscence or stricture could be attributed to in 7.7% patients. 3.8% had to have their ileostomies converted to a permanent colostomy due to either a rectovaginal fistula or dehiscence or stricture. The complications associated with ileostomy are not insignificant. In our study, the tumor location in lower rectum was the only significant factor for non-reversal. We have to objectively identify patients who are at low risk for leakage and avoid ileostomy in them, and also try to minimize the morbidity of ileostomy by methods like early closure.
Collapse
Affiliation(s)
- Arun Peter Mathew
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Srinidhi M
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Chandramohan K
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Madhu Muralee
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Mira Wagh
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
| |
Collapse
|
9
|
Grönroos-Korhonen MT, Koskenvuo LE, Mentula PJ, Koskensalo SK, Leppäniemi AK, Sallinen VJ. Failure to rescue after reoperation for major complications of elective and emergency colorectal surgery: A population-based multicenter cohort study. Surgery 2022; 172:1076-1084. [DOI: 10.1016/j.surg.2022.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/23/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023]
|
10
|
The Effects of Anastomotic Leaks on the Net Revenue from Colon Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159426. [PMID: 35954784 PMCID: PMC9368338 DOI: 10.3390/ijerph19159426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023]
Abstract
Background: Complications in colon surgery can have severe health consequences, while at the same time, they are associated with increased costs. An anastomotic leak (AL) is associated with significantly increased costs compared to cases without. The aim of our analysis was to evaluate, which individual processes and patient-unrelated factors influencing the treatment process of colon surgery are responsible for the financial burden in patients with AL. Methods: Data from 263 patients who underwent colon surgery in Wetzikon hospital between January 2018 and December 2020 and was analyzed. In these 263 cases, 12 anastomotic leaks occurred and were compared with 36 cases without AL using a Propensity Score Matching (PSM). The covariates for the PSM have been Age, Sex, and Type of Surgery (t value: −3.26, p-value: 0.001). Results: A total of 48 surgeries were broken down in terms of costs and profitability. This reflected a mean deficit of −37,527 CHF per case (range from −130.05 to +755 CHF) for patients with AL, whereas a mean profit of 1590 CHF per case (range from −24.37 to +12.65 CHF) for those without AL (p < 0.001). Thus, the difference in profit showed a factor of 24.6 with an overall significant negative outcome for the occurrence of AL. The main cost contributing factors were the length of hospital stay (~p < 0.05) and length of intensive care (p < 0.05), whereas neither surgical operation time and anesthesia time nor surgical access, insurance status, indication or type of operation had a significant influence on the net revenue. Conclusion: AL after colon surgery leads to a significant deficit regarding the net revenue. Regarding process optimization, our analysis identified several sectors of non-patient-related, yet cost-influencing variables that should be addressed in future evaluations and optimization of the colon surgery treatment processes.
Collapse
|
11
|
Moukarzel LA, Zivanovic O. Updates to the Literature on Anastomotic Leaks After Rectosigmoid Resection for Gynecologic Malignancies. Ann Surg Oncol 2022; 29:4670-4672. [PMID: 35583692 DOI: 10.1245/s10434-022-11823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| |
Collapse
|
12
|
Chiarello MM, Brisinda G. A Commentary on "Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review" (Int. J. Surg. 2022; 100: 106592). Int J Surg 2022; 101:106624. [PMID: 35472516 DOI: 10.1016/j.ijsu.2022.106624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Maria Michela Chiarello
- Department of Surgery, Ospedale di San Giovanni in Fiore, Azienda Sanitaria Provinciale di Cosenza, Italy
| | - Giuseppe Brisinda
- Università Cattolica del Sacro Cuore, Roma, Italy; Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy.
| |
Collapse
|
13
|
You X, Zhao X, Huang C, Cheng Z, Liu G, Shen X, Zheng T. Duodenal-Distal Ileal Fistula After Laparoscopic Radical Right Hemicolectomy: A Case Report. Front Surg 2022; 9:851348. [PMID: 35310444 PMCID: PMC8927646 DOI: 10.3389/fsurg.2022.851348] [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: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Right hemicolectomy for colon cancer may be complicated by leaks, stenoses, or fistulas. These complications usually occur at the ileocolic anastomosis and can be managed endoscopically. However, fistulas that are large cannot be managed by endoscopy and require surgical intervention. After laparoscopic radical right hemicolectomy, duodenal fistulae is relatively rare. Among duodenal fistulae, internal duodenocolic fistulae is relatively common, but duodeno-ileum fistulae is extremely rare. Here, we report a case of duodeno-distal ileum fistula after right hemicolectomy with short bowel syndrome, that was surgically treated. After surgical treatment, the symptoms of short bowel syndrome disappeared, weight gain was obvious, and the clinical effect was satisfactory.
Collapse
Affiliation(s)
- Xiaolan You
- Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
- *Correspondence: Xiaolan You
| | - Xiaojun Zhao
- Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
| | - Chuanjiang Huang
- Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
| | - Zhiyi Cheng
- Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
| | - Guiyuan Liu
- Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
| | | | | |
Collapse
|
14
|
Ileocolic anastomosis after right hemicolectomy: stapled end-to-side, stapled side-to-side, or handsewn? Int J Colorectal Dis 2022; 37:673-681. [PMID: 35124716 DOI: 10.1007/s00384-022-04102-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leak (AL) following ileocolic anastomosis is a cause of significant morbidity and mortality. Stapled end-to-side (ESA), stapled side-to-side (SSA), and handsewn anastomoses (HSA) are commonly performed techniques. There is however conflicting data on the superiority of one technique over the other. The aim of this study was to compare the outcomes of ESA against SSA and HSA. METHODS This retrospective cohort study was conducted at a tertiary colorectal unit. All patients who underwent an ileocolic anastomosis from October 2008 to May 2020 were included. Exclusion criteria were missing data on anastomotic technique or clinicopathological variables. Primary outcomes were AL and anastomotic bleeding (AB). Secondary outcomes were length of stay (LoS) and return of gut function. RESULTS A total of 1390 patients met the inclusion criteria. A total of 976 (70%) ESA, 308 (22%) SSA, and 108 (8%) HSA were performed. AL occurred in 17/1390 (1.2%) patients, and 54/1390 (3.9%) had AB. On adjusted analysis, ESA experienced a lower AL when compared with SSA (OR 4.93, p = 0.005), with a trend towards a lower AL when compared to HSA (OR 2.6, p = 0.27). There was no difference in AB between all techniques: ESA vs. SSA (OR 1.07 p = 0.84), and ESA vs. HSA (OR 0.24 p = 0.76). Both stapled techniques were associated with a shorter return to gut function compared to HSA; 3.3 vs. 4.2 days (p < 0.001). There was no difference in LoS. CONCLUSION ESA has the lowest leak rate when compared to other anastomotic techniques without any increased risk of anastomotic bleeding.
Collapse
|
15
|
Wang WY, Chen CW, Wang TJ, Lin KL, Liu CY. Outcomes of early enteral feeding in patients after curative colorectal cancer surgery: A retrospective comparative study. Eur J Oncol Nurs 2021; 54:101970. [PMID: 34496304 DOI: 10.1016/j.ejon.2021.101970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/03/2021] [Accepted: 04/18/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare the clinical outcomes of patients with and without early enteral nutrition after colorectal cancer surgery. METHODS This is a retrospective comparative study using propensity score-matched cases. The study subjects were patients who received colorectal cancer resection surgeries during 2013 and 2018 in a Taiwan medical center. Data of the following variables were retrieved from subjects' medical records: age, sex, diagnosis, pathological stage, surgical approach, comorbidity, risk of malnutrition, anesthesia duration, enteral nutrition, time to the first postoperative flatus, time to the first defecation, feeding associated symptoms, nutrition interruptions, time to achieve nutrition goals, postoperative complications, the length of hospital stay. Subjects who received enteral nutrition within 48 h after the surgery were considered as the early enteral nutrition group. RESULTS After propensity score matching, 227 subjects in each group were included in the final analysis. The early enteral nutrition group showed better results in the time to first postoperative flatus (mean difference: 0.96, 95% confidence interval: 1.16 ~ -0.76), the time to achieve nutrition goals (mean difference: 1.26, 95% confidence interval: 0.65 ~ -1.87), and the length of hospital stay (mean difference: 1.53, 95% confidence interval: 2.56 ~ -0.42), compared with the delayed enteral nutrition group. There were no between-group differences in the incidences of vomiting, distension, ileus, anastomosis leak, infection, re-operation, and interruptions of enteral nutrition. CONCLUSIONS Enteral feeding after colorectal cancer surgery can accelerate the recovery of gastrointestinal tract activities, promote nutrient intake, and shorten the length of hospital stay without increasing postoperative complications.
Collapse
Affiliation(s)
- Wen Yin Wang
- Nurse Practitioner, Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - Chung-Wei Chen
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - Tsae-Jyy Wang
- Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC.
| | - Keng-Li Lin
- Diversion of Colorectal Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
| | - Chieh-Yu Liu
- Department of Speech-Language Pathology and Audiology, National Taipei University of Nursing and Health Science, Taipei, Taiwan, ROC.
| |
Collapse
|
16
|
Abdominal Wall Defects-Current Treatments. CHILDREN-BASEL 2021; 8:children8020170. [PMID: 33672248 PMCID: PMC7926339 DOI: 10.3390/children8020170] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023]
Abstract
Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different techniques and timings are used depending on type and size of defect, the abdominal domain and comorbidities of the child. The present review aims to provide an overview of current treatments.
Collapse
|
17
|
Fortin SP, Johnston SS, Chaudhuri R, Fryrear R, Roy S. Incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. J Med Econ 2021; 24:255-265. [PMID: 33576292 DOI: 10.1080/13696998.2021.1880749] [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] [Indexed: 10/22/2022]
Abstract
STUDY AIM Manual circular staplers are widely used in colorectal surgery; however, limited literature exists examining complications related to circular anastomoses when such devices are used. The present study evaluated the incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. MATERIALS AND METHODS Patients aged ≥18 years who underwent hemicolectomy, low anterior resection, or sigmoidectomy between 1 October 2016 and 31 December 2018 were identified from the Premier Healthcare Database. Manual circular stapler use was identified from hospital administrative billing records. Circular anastomotic complications were defined as a composite endpoint of multiple circular stapler use (proxy for stapler failure) or other circular anastomotic complications (anastomotic leak, bleeding, device/surgical complications, infection, and transfusion). Multivariable analyses were used to model the associations between circular anastomotic complications and total hospital costs, length of stay, operating room time, and 30-, 60-, and 90-day readmission rates. RESULTS A total of 13,167 patients met the study criteria, of whom 2,984 (22.7%) had circular anastomotic complications. Predictors of circular anastomotic complications included age, procedure type, provider region, and select patient comorbidities. As compared with those who did not, patients who suffered circular anastomotic complications had significantly higher adjusted total hospital costs ($26,924 vs. $18,748; p < .0001), length of stay (7.79 vs. 4.99 days; p < .0001), operating room time (280 vs. 239 min; p < .0001), non-home discharge status (9.63% vs. 4.61%; p < .0001), and all-cause readmission at 30 days (12.2% vs. 8.7%; p < .0001), 60 days (16.0% vs. 11.6%; p < .0001), and 90 days (18.5% vs. 13.4%; p < .0001). LIMITATIONS The present study is limited by the observational nature and potential for measurement error that is inherent to administrative healthcare databases. CONCLUSIONS In this analysis of patients undergoing left-sided colorectal reconstructions involving a manual circular stapler, circular anastomotic complications were associated with adverse economic consequences.
Collapse
Affiliation(s)
- Stephen P Fortin
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | - Stephen S Johnston
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | | | - Raymond Fryrear
- Preclinical, Clinical, Medical Centre, Ethicon Inc., Cincinnati, OH, USA
| | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon Inc., Cincinnati, OH, USA
| |
Collapse
|
18
|
Staerkle RF, Guglielmetti LC, Bielicki IN, Gaukel S, Frongia G, Hilton S, Fink L, Vuille-dit-Bille RN. Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e21501. [PMID: 32756186 PMCID: PMC7402905 DOI: 10.1097/md.0000000000021501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is still not clear if the contralateral side should be explored in children with unilateral inguinal hernias. The primary aim of the present study was to assess the incidence of metachronous contralateral inguinal hernias (MCIHs) in the pediatric population. The second aim was to assess factors associated with increased risk of MCIH development. METHODS Prospective studies including patients from 0-19 years undergoing unilateral inguinal hernia repair without surgical exploration of the contralateral side between 1947 and April 2020 with a minimal follow-up of one year were searched. Searches included EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. RESULTS Seven studies involving 1774 children (1452 boys (82%) and 322 girls (18%) were identified. Overall the incidence of MCIH was 6%. Incidence of MCIH development was significantly higher in children with initial left-sided (9%) versus right-sided (3%) hernia (OR 2.55 with 95% CI from 1.56 to 4.17; P = 0.0002), in female (8%) versus male (4%) children (OR 1.74 with 95% CI from 1.01 to 3.01; P = 0.0469) and in patients with open (14%) versus closed (3%) contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9; P = 0.0202). There was no significant difference in MCIH development depending on follow-up duration (follow-up of ≤2 years (i.e. 1-2 years): calculated MCIH incidence 5% (95% CI from 0.00 to 0.11%; 3 studies; 569 patients), follow-up of ≥3 years (i.e. 3-4 years): 6% (95% CI from 0.03 to 0.09; 3 studies, 983 patients)) or patients' age (MCIH incidence in children <1 year: 6.9%; older children: 4.5%; OR 1.87 with 95% CI from 0.97 to 3.62; P = 0.0618). CONCLUSIONS Overall incidence of MCIH development is 6%. Initial left-sided hernia, female gender and open CPV are risk factors for MCIH development.
Collapse
Affiliation(s)
- Ralph F. Staerkle
- Clarunis University Center for Gastrointestinal and Liver Diseases, Basel
| | - Laura C. Guglielmetti
- Department of Visceral und Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur
| | | | - Stefan Gaukel
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Hilton
- Department of Surgery, University of Colorado, Aurora, CO
| | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St Gallen, Switzerland
| | | |
Collapse
|