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Reynolds IS. An acute care surgeons's dilemma: Operative vs. non-operative management of emergency general surgery conditions in patients with recent colorectal cancer treatment. Am J Surg 2024; 227:13-14. [PMID: 38587049 DOI: 10.1016/j.amjsurg.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 04/09/2024]
Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, 9, Ireland.
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2
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Mazepa MM, Pereira MA, Arabi AYM, Dias AR, Ribeiro U, Zilberstein B, D’Albuquerque LAC, Ramos MFKP. Gastroduodenal Perforation in Cancer Patients: Association with Chemotherapy and Prognosis. Med Sci (Basel) 2023; 11:medsci11020026. [PMID: 37092495 PMCID: PMC10123675 DOI: 10.3390/medsci11020026] [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: 02/26/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. Method: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. Results: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. Conclusions: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.
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de Nes LCF, Hannink G, ‘t Lam-Boer J, Hugen N, Verhoeven RH, de Wilt JHW. OUP accepted manuscript. BJS Open 2022; 6:6561580. [PMID: 35357416 PMCID: PMC8969795 DOI: 10.1093/bjsopen/zrac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/16/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background As the outcome of modern colorectal cancer (CRC) surgery has significantly improved over the years, however, renewed and adequate risk stratification for mortality is important to identify high-risk patients. This population-based study was conducted to analyse postoperative outcomes in patients with CRC and to create a risk model for 30-day mortality. Methods Data from the Dutch Colorectal Audit were used to assess differences in postoperative outcomes (30-day mortality, hospital stay, blood transfusion, postoperative complications) in patients with CRC treated from 2009 to 2017. Time trends were analysed. Clinical variables were retrieved (including stage, age, sex, BMI, ASA grade, tumour location, timing, surgical approach) and a prediction model with multivariable regression was computed for 30-day mortality using data from 2009 to 2014. The predictive performance of the model was tested among a validation cohort of patients treated between 2015 and 2017. Results The prediction model was obtained using data from 51 484 patients and the validation cohort consisted of 32 926 patients. Trends of decreased length of postoperative hospital stay and blood transfusions were found over the years. In stage I–III, postoperative complications declined from 34.3 per cent to 29.0 per cent (P < 0.001) over time, whereas in stage IV complications increased from 35.6 per cent to 39.5 per cent (P = 0.010). Mortality decreased in stage I–III from 3.0 per cent to 1.4 per cent (P < 0.001) and in stage IV from 7.6 per cent to 2.9 per cent (P < 0.001). Eight factors, including stage, age, sex, BMI, ASA grade, tumour location, timing, and surgical approach were included in a 30-day mortality prediction model. The results on the validation cohort documented a concordance C statistic of 0.82 (95 per cent c.i. 0.80 to 0.83) for the prediction model, indicating good discriminative ability. Conclusion Postoperative outcome improved in all stages of CRC surgery in the Netherlands. The developed model accurately predicts postoperative mortality risk and is clinically valuable for decision-making.
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Affiliation(s)
- Lindsey C. F. de Nes
- Department of Surgery, Maasziekenhuis Pantein, Beugen, The Netherlands
- Department of Surgery, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands
- Correspondence to: Lindsey C.F. de Nes, Maasziekenhuis Pantein, Department of Surgery, Dokter Kopstraat 1, 5835 DV Beugen, The Netherlands (e-mail: )
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Jorine ‘t Lam-Boer
- Department of Surgery, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Niek Hugen
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
| | - Rob H. Verhoeven
- Department of Surgery, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Johannes H. W. de Wilt
- Department of Surgery, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands
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Stewart CL, Tran TB, Nguyen A, Zain J, Lai L, Fong Y, Woo Y. Cholecystectomy in patients with hematologic malignancies. Am J Surg 2021; 223:1157-1161. [PMID: 34711411 DOI: 10.1016/j.amjsurg.2021.10.037] [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: 07/28/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cholecystectomy in patients with hematologic malignancies remains poorly understood. METHODS We retrospectively evaluated patients with hematologic malignancies who underwent cholecystectomy at a single institution. RESULTS Of 313 patients who presented for evaluation of abdominal pain, 64 underwent cholecystectomy for acute cholecystitis (34.4%), gangrenous cholecystitis (21.9%), chronic cholecystitis (23.4%), and cholelithiasis (20%). Most had a history of hematopoietic cell transplantation (62.5%) and/or immunosuppressive medication within 30 days of consultation (82.8%). Ultrasound had a 39% false-negative rate for acute nongangrenous cholecystitis. Operative time was 92 ± 39 min, 7 were performed open, 10 had intraoperative transfusions, and 4 had grade 3+ complications. Intraoperative transfusion was associated with increased postoperative length of stay (p = 0.03). Open procedure, operative time, estimated blood loss, intraoperative transfusion, and complications were not associated with timing of surgery. CONCLUSIONS Patients with hematologic malignancies can safely undergo cholecystectomy. Length of postoperative stay for inpatients is associated with intraoperative blood transfusion.
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Affiliation(s)
| | - Thuy B Tran
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Andrew Nguyen
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Jasmine Zain
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Lily Lai
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Yanghee Woo
- Department of Surgery, City of Hope, Duarte, CA, USA.
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Park SH, Kim T, Cha WC, Yoon H, Hwang SY, Shin TG, Sim MS, Jo I, Lee S, Park H, Choi J. Cardiac troponin I predicts clinical outcome of patients with cancer at emergency department. Clin Cardiol 2020; 43:1585-1591. [PMID: 33085130 PMCID: PMC7724208 DOI: 10.1002/clc.23486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The prognostic ability of cardiac troponin I (TnI) has been demonstrated in general populations and among cardiovascular disease patients, but it has not been evaluated in cancer patients. HYPOTHESIS This study assumes to have the prognostic ability of cardiac troponin in cancer patients visiting the emergency department. METHODS Cancer patients visiting the emergency department were enrolled in this retrospective cohort study. Patients with previously known coronary artery disease or clinically indicated coronary angiography were not included. The maximal value from Siemens ADVIA Centaur troponin I Ultra assay within 24 hours was assessed. The primary endpoint was 180-day all-cause death, including cardiovascular and noncardiovascular death. RESULTS A total of 9135 cancer patients (mean age: 63 years, male gender: 60%) were enrolled. Lowest (0.006 ng/mL), assay-specific <99th % (0.007-0.039 ng/mL), below median ≥ 99th % (0.040-0.129 ng/mL), and above median ≥ 99th % (≥0.130 ng/mL) TnI were found in 4487 (49.1%), 3158 (34.6%), 852 (9.3%), and 638 (7.0%) patients, respectively. There was 3192 (34.9%) all-cause deaths including 137 (1.5%) cardiovascular and 3047 (33.4%) noncardiovascular deaths in the 180-day follow-up period. The risks of all-cause, cardiovascular, and noncardiovascular death increased across higher TnI strata (hazard ratio [HR] = 1.3-2.9; 2.1-9.3; 1.3-1.8; P < .001, all). These findings were consistent within clinical subgroups including solid and hematologic cancers. CONCLUSIONS Cancer patients visiting the emergency department with elevated troponin I were at increased risk of 180-day death. Cancer patients with elevated TnI may need additional evaluation or careful follow-up even without cardiovascular disease diagnosis.
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Affiliation(s)
- Soo Hyun Park
- Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulSouth Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Won Cul Cha
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - IkJoon Jo
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung‐Hwa Lee
- Department of MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyung‐Doo Park
- Department of Laboratory Medicine and GeneticsSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jin‐Ho Choi
- Department of Emergency Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
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6
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Maeda Y, Shinohara T, Minagawa N, Kobayashi T, Koyama R, Shimada S, Tsunetoshi Y, Murayama K, Hasegawa H. A retrospective analysis of emergency surgery for cases of acute abdomen during cancer chemotherapy. Case series. Ann Med Surg (Lond) 2020; 57:143-147. [PMID: 32760583 PMCID: PMC7393459 DOI: 10.1016/j.amsu.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background Treatment for acute abdomen during chemotherapy is frequently difficult because of the complicated status of the patients, and there have been only a few case series summarizing the outcomes of emergent surgery during chemotherapy. The aim of this study was to clarify the clinical outcomes of emergency surgery for acute abdomen during chemotherapy and identify predictive factors associated with mortality. Methods We retrospectively analyzed the records of patients who underwent emergency surgery for acute abdomen within 30-days after anti-cancer drugs administration between 2009 and 2020. Results Thirty patients were identified. The primary malignancies were hematological (n = 7), colorectal (n = 4), lung (n = 4), stomach (n = 2), breast (n = 2), prostate (n = 2) and others (n = 5). Fifteen patients were treated with the regimen, including molecular-targeted anti-cancer drugs (Bevacizumab: 8 cases, Rituximab: 4, Ramucirumab: 2, and Gefitinib: 1). Indications for emergency surgery were perforation of the gastrointestinal tract (n = 24), appendicitis (n = 3), bowel obstruction (n = 2), and gallbladder perforation (n = 1). Severe morbidity (Clavien-Dindo IIIa or more) occurred in 8 cases (27%), and there were 6 in-hospital deaths (20%). Significant factors related to in-hospital death were age >70 years old (P = 0.029), poor performance status (ECOG score 1 or 2) (P = 0.0088), and serum albumin level <2.6 g/dl (P = 0.026). The incidence of acute abdomen (odds ratio 5.31, P = 0.00017) was significantly higher in the patients receiving anti-VEGF drugs than in those without anti-VEGF drugs. Conclusion This study identified three predictive factors associated with in-hospital death after emergency surgery during chemotherapy: an older age, poor performance status, and low serum albumin level.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | | | - Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Shingo Shimada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Yusuke Tsunetoshi
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Keisuke Murayama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Haruka Hasegawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
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Jochem C, Leitzmann M, Volaklis K, Aune D, Strasser B. Association Between Muscular Strength and Mortality in Clinical Populations: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2019; 20:1213-1223. [DOI: 10.1016/j.jamda.2019.05.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 12/17/2022]
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8
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Tan AL, Iyer NG, Putri N, Nadkarni N, Skanthakumar T, Wong TH, Tay GCA. Factors driving frequent attendance at emergency departments for patients with head and neck cancer. Head Neck 2019; 41:3798-3805. [PMID: 31423688 DOI: 10.1002/hed.25916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/28/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer have a higher risk of emergency department (ED) frequent attender (FA). We hypothesized that FAs present with issues different from non-FAs. METHODS A retrospective cohort study was conducted on Singapore residents with head and neck cancers using de-identified registry merged with electronic medical record data. A competing risk regression analysis was performed to identify factors associated with FA. Aggregated primary diagnoses were compared for patients with and without FA risk factors. RESULTS Thirteen percent of patients with head and neck cancer were FAs. FA risk factors were Charlson comorbidity index (3+), and socioeconomic status (SES). FAs had a higher proportion of respiratory infections. The spectrum of diagnosis was similar for patients with low and high SES. Current smokers had a greater proportion of respiratory complaints, relative to never smokers. CONCLUSION Patients with greater comorbidity scores or higher SES were more likely to be FA. FAs were more likely to present with respiratory complaints, likely related to cancer treatment, or smoking status.
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Affiliation(s)
- Aidan L Tan
- Preventive Medicine, National University Hospital, Singapore.,Health Services Research Unit, Singapore General Hospital, Singapore
| | - Narayanan Gopalakrishna Iyer
- Health Services Research Unit, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore
| | - Natascha Putri
- Division of Surgical Oncology, National Cancer Centre, Singapore.,Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore
| | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | | | - Ting Hway Wong
- General Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Gerald Ci An Tay
- Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore.,General Surgery, Singapore General Hospital, Singapore
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9
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Wong TH, Lau ZY, Ong WS, Tan KB, Wong YJ, Farid M, Teo MCC, Yee ACP, Nguyen HV, Ong MEH, Iyer NG. Cancer patients as frequent attenders in emergency departments: A national cohort study. Cancer Med 2018; 7:4434-4446. [PMID: 30117313 PMCID: PMC6144141 DOI: 10.1002/cam4.1728] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer-related hospitalization. METHODS A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12-month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan-Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses. RESULTS Records for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28-3.74; 75-84 years, HR 1.29, 95% CI 1.16-1.45; and ≥85 years, HR 1.71, 95% CI 1.45-2.02, relative to age 55-64), male gender (HR 1.26, 95% CI 1.16-1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19-1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23-1.59; housing subsidy type, HR 2.12, 95% CI 1.77-2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67-3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27-3.31; hypopharynx, HR 2.72, 95% CI 1.56-4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13-2.18; pleural, HR 3.69, 95% CI 2.12-6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26-2.74; esophagus, HR 4.13, 95% CI 2.78-6.13), hepato-pancreato-biliary (liver, HR 1.42, 95% CI 1.01-2.00, pancreas, HR 2.48, 95% CI 1.72-3.59), and certain hematological malignancies (diffuse non-Hodgkin's lymphoma, HR1.59, 95% CI 1.08-2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21-2.86). Brain (HR 1.69, 95% CI 1.27-2.26), lung (HR 1.31, 95% CI 1.01-1.71), liver (HR 1.46, 95% CI 1.14-1.89), and bone (HR 1.35, 95% CI 1.04-1.76) metastases were also associated with FA. CONCLUSION There are cancer-specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high-risk groups and prevent unnecessary ED use.
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Affiliation(s)
- Ting Hway Wong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Zheng Yi Lau
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | | | - Kelvin Bryan Tan
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
- Saw Swee Hock School of Public HealthSingaporeSingapore
| | - Yu Jie Wong
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | - Mohamad Farid
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Melissa Ching Ching Teo
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Alethea Chung Pheng Yee
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Hai V. Nguyen
- School of PharmacyMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Marcus Eng Hock Ong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - N. Gopalakrishna Iyer
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
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Boselli C, Cirocchi R, Gemini A, Grassi V, Avenia S, Polistena A, Sanguinetti A, Burattini MF, Pironi D, Santoro A, Tabola R, Avenia N. Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery. Aging Clin Exp Res 2017; 29:65-71. [PMID: 27837462 DOI: 10.1007/s40520-016-0642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications. MATERIALS AND METHODS We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation. DISCUSSION Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer. CONCLUSIONS The surgical choice should be made case by case (custom-made), not based on age only.
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Affiliation(s)
- Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Andrea Polistena
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Maria Federica Burattini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
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11
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Tambasco N, Mastrodicasa E, Salvatori C, Mancini G, Romoli M, Caniglia M, Calabresi P, Verrotti A. Prognostic factors in children with PRES and hematologic diseases. Acta Neurol Scand 2016; 134:474-483. [PMID: 26876986 DOI: 10.1111/ane.12570] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized by focal neurological signs, headache, confusion, and seizure, associated with transitory lesions in the posterior areas of the brain detectable with neuroimaging. Among children, one of the most common causes of PRES is cancer. MATERIALS AND METHODS In this review, we present the cases of 5 children developing PRES after stem cell transplantation for hematological disease and review all the cases reported in English literature to investigate outcomes and associated risk factors. RESULTS One hundred and eleven cases were reported. Hypertension was very frequent (80%). Clinical features included seizures (80.1%), headache (44.1%), visual disturbance (26.1%), and mental change (48.6%). EEG was abnormal in 27 of 32 patients. MRI revealed characteristic lesions in all patients even in early stages. Abnormal MRI findings in late stages were associated with neurological sequelae. Nineteen patients died (17.1%) of which 2 of PRES. Among alive patients, 17 had neurological sequelae. Four cases of PRES relapse were described. CONCLUSIONS Thus, all transplant recipients with symptoms consistent with PRES should be promptly recognized to avoid long-term complications or even death.
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Affiliation(s)
- N. Tambasco
- Department of Neurology; Perugia General Hospital and University of Perugia; Perugia Italy
| | - E. Mastrodicasa
- Pediatric Oncology Hematology Unit; Perugia General Hospital; Perugia Italy
| | - C. Salvatori
- Department of Pediatrics; Perugia General Hospital and University of Perugia; Perugia Italy
| | - G. Mancini
- Department of Pediatrics; Perugia General Hospital and University of Perugia; Perugia Italy
| | - M. Romoli
- Department of Neurology; Perugia General Hospital and University of Perugia; Perugia Italy
| | - M. Caniglia
- Pediatric Oncology Hematology Unit; Perugia General Hospital; Perugia Italy
| | - P. Calabresi
- Department of Neurology; Perugia General Hospital and University of Perugia; Perugia Italy
- IRCCS Fondazione Santa Lucia; Roma Italy
| | - A. Verrotti
- Department of Pediatrics; University of L'Aquila; Italy
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