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Liu S, Huang N, Wei C, Wu Y, Zeng L. Is mechanical bowel preparation mandatory for elective colon surgery? A systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:99. [PMID: 38504007 DOI: 10.1007/s00423-024-03286-z] [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: 09/27/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Growing evidence demonstrates minimal impact of mechanical bowel preparation (MBP) on reducing postoperative complications following elective colectomy. This study investigated the necessity of MBP prior to elective colonic resection. METHOD A systematic literature review was conducted across PubMed, Ovid, and the Cochrane Library to identify studies comparing the effects of MBP with no preparation before elective colectomy, up until May 26, 2023. Surgical-related outcomes were compiled and subsequently analyzed. The primary outcomes included the incidence of anastomosis leakage (AL) and surgical site infection (SSI), analyzed using Review Manager Software (v 5.3). RESULTS The analysis included 14 studies, comprising seven RCTs with 5146 participants. Demographic information was consistent across groups. No significant differences were found between the groups in terms of AL ((P = 0.43, OR = 1.16, 95% CI (0.80, 1.68), I2 = 0%) or SSI (P = 0.47, OR = 1.20, 95% CI (0.73, 1.96), I2 = 0%), nor were there significant differences in other outcomes. Subgroup analysis on oral antibiotic use showed no significant changes in results. However, in cases of right colectomy, the group without preparation showed a significantly lower incidence of SSI (P = 0.01, OR = 0.52, 95% CI (0.31, 0.86), I2 = 1%). No significant differences were found in other subgroup analyses. CONCLUSION The current evidence robustly indicates that MBP before elective colectomy does not confer significant benefits in reducing postoperative complications. Therefore, it is justified to forego MBP prior to elective colectomy, irrespective of tumor location.
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Affiliation(s)
- Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ning Huang
- Department of Stomatology, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Changcheng Wei
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Yuehong Wu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Lin Zeng
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China.
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Preoperative Oral-Bowel Preparation Using Sodium Picosulfate and Magnesium Citrate Combination Powder for Left-Sided Colorectal Cancer: A Prospective Study. Int Surg 2022. [DOI: 10.9738/intsurg-d-20-00038.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study aimed to determine if induction of sodium picosulfate and magnesium citrate (SPMC) preparation leads to adequate surgery for left-sided colorectal cancer (CRC).
Summary of Background Data
Adequate bowel cleansing is vital for safe and accurate colorectal surgery. Ingestion of laxatives for bowel cleansing may be associated with a broad spectrum of adverse effects during surgical intervention.
Methods
A single-center prospective study was conducted with hospitalized patients scheduled operation for left-sided CRC. All enrolled patients were instructed to consume normal diet until before preparation. Twenty-seven patients underwent preoperative SPMC preparation.
Results
The primary endpoint of this study was the 30-day postoperative morbidity rate, which was 23%, and no postoperative complication was higher than Clavien-Dindo grade 3. The primary anastomosis rate was 100%, and there was no anastomotic leakage. The colonic cleansing grades were 1 or 2 according to the bowel preparation scale for surgical assessment in 89% of the patients. The acceptability of the cleansing procedure by the patients assessed by a questionnaire was 85%, and the acceptability of the SPMC preparation by the medical staff was 93%. The surgical procedures included 18 laparoscopies, 6 robotic surgeries, and 3 laparotomies. The median operation time was 165 minutes, and the median blood loss was <50 cc. The median sodium serum concentration was significantly decreased after surgery.
Conclusion
Ingestion of an SPMC preparation as a cleansing procedure was judged to be adequate for curative surgery in patients with left-sided colorectal cancer.
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3
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Kim IY. [Role of Mechanical Bowel Preparation for Elective Colorectal Surgery]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 75:79-85. [PMID: 32098461 DOI: 10.4166/kjg.2020.75.2.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 01/14/2023]
Abstract
The presence of bowel contents during colorectal surgery has been related to surgical site infections (SSI), anastomotic leakage (AL) and postoperative complications theologically. Mechanical bowel preparation (MBP) for elective colorectal surgery aims to reduce fecal materials and bacterial count with the objective to decrease SSI rate, including AL. Based on many observational data, meta-analysis and multicenter randomized control trials (RTC), non-MBP did not increase AL rates or SSI and other complications in colon and even rectal surgery. In 2011 Cochrane review, there is no significant benefit MBP compared with non-MBP in colon surgery and also no better benefit MBP compared with rectal enemas in rectal surgery. However, in surgeon's perspectives, MBP is still in widespread surgical practice, despite the discomfort caused in patients, and general targeting of the colon microflora with antibiotics continues to gain popularity despite the lack of understanding of the role of the microbiome in anastomotic healing. Recently, there are many evidence suggesting that MBP+oral antibiotics (OA) should be the growing gold standard for colorectal surgery. However, there are rare RCT studies and still no solid evidences in OA preparation, so further studies need results in both MBP and OA and only OA for colorectal surgery. Also, MBP studies in patients with having minimally invasive surgery (MIS; laparoscopic or robotics) colorectal surgery are still warranted. Further RCT on patients having elective left side colon and rectal surgery with primary anastomosis in whom sphincter saving surgery without MBP in these MIS and microbiome era.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Division of Colorectal Surgery, Department of Surgery, Wonju Severance Christian Hospital, Wonju, Korea
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Shalaby M, Thabet W, Morshed M, Farid M, Sileri P. Preventive strategies for anastomotic leakage after colorectal resections: A review. World J Meta-Anal 2019; 7:389-398. [DOI: 10.13105/wjma.v7.i8.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023] Open
Abstract
Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.
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Affiliation(s)
- Mostafa Shalaby
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
- Department of General Surgery UOC C, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome 00133, Italy
| | - Waleed Thabet
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Mosaad Morshed
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Mohamed Farid
- Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
| | - Pierpaolo Sileri
- Department of General Surgery UOC C, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome 00133, Italy
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Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg 2018; 71:227-236. [PMID: 29564651 DOI: 10.1007/s13304-018-0526-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/11/2018] [Indexed: 02/08/2023]
Abstract
It has been a standard practice to perform mechanical bowel preparation (MBP) prior to colorectal surgery to reduce the risk of colorectal anastomotic leakages (CAL). The latest Cochrane systematic review suggests there is no benefit for MBP in terms of decreasing CAL, but new studies have been published. The aim of this systematic review and meta-analysis is to update current evidence for the effectiveness of preoperative MBP on CAL in patients undergoing colorectal surgery. Consequently, PubMed, MEDLINE, Embase, CENTRAL and CINAHL were searched from 2010 to March 2017 for randomised controlled trials (RCT) that compared the effects of MBP in colorectal surgery on anastomotic leakages. The outcome CAL was expressed in odds ratios and analysed with a fixed-effects analysis in a meta-analysis. Quality assessment was performed by the cochrane risk of bias tool and grades of recommendation, assessment, development and evaluation (GRADE) methodology. Eight studies (1065 patients) were included. The pooled odds ratio showed no significant difference of MBP in colorectal surgery on CAL (odds ratio (OR) = 1.15, 95% CI = 0.68-1.94). According to GRADE methodology, the quality of the evidence was low. To conclude, MBP for colorectal surgery does not lower the risk of CAL. These results should, however, be interpreted with caution due to the small sample sizes and poor quality. Moreover, the usefulness of MBP in rectal surgery is not clear due to the lack of stratification in many studies. Future research should focus on high-quality, adequately powered RCTs in elective rectal surgery to determine the possible effects of MBP.
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7
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Kim YW, Kim IY. Comparison of the Short-Term Outcomes of Laparoscopic and Open Resections for Colorectal Cancer in Patients with a History of Prior Median Laparotomy. Indian J Surg 2017; 79:527-533. [PMID: 29217904 DOI: 10.1007/s12262-016-1520-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023] Open
Abstract
This study aimed to investigate the short-term outcomes of laparoscopic resection in comparison with those of open resection for colorectal cancer in patients with a history of prior median laparotomy (PML). Eighty-seven consecutive patients (87/1121, 7.8 %) with a history of PML who underwent major colorectal cancer resection were enrolled (laparoscopy, n = 40; open, n = 47). The conversion rate to open surgery was 25 % (n = 10). The laparoscopy group had a higher proportion of female patients (57.5 vs. 36.2 %), a lower rate of American Society of Anesthesiologists (ASA) score for physical status of ≥3 (7.5 vs. 25.5 %), and a lower pT4 tumor rate (15 vs. 38.3 %) than the open resection group. Regarding the reasons for PML, radical hysterectomy with extended lymphadenectomy for gynecologic cancer was more common (32.5 vs. 4.3 %), but gastrointestinal surgeries, such as gastrectomy and colectomy, were less frequent in the laparoscopy group. Regarding intraoperative outcomes, the laparoscopy group showed a similar operative time (197 vs. 204 min), intraoperative enterotomy rate (2.5 vs. 2.1 %), and bowel resection rate (2.5 vs. 2.1 %) with the open resection group. Regarding postoperative outcomes, the laparoscopy group showed a lower complication rate (20 vs. 40.4 %), significantly reduced time to soft diet (5 vs. 7 days), and shorter hospital stay (12 vs. 18 days). Despite the high rate of open conversion, favorable short-term outcomes were observed in the laparoscopic group. Laparoscopy may be chosen as the primary approach in selected patients with a history of non-gastrointestinal PML (prior abdominal surgery for gynecological cancer).
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Affiliation(s)
- Young Wan Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do 26426 Republic of Korea
| | - Ik Yong Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do 26426 Republic of Korea
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8
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van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, Slooter GD. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg 2016; 36:183-200. [PMID: 27756644 DOI: 10.1016/j.ijsu.2016.09.098] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation. METHODS Two independent literature searches were performed using EMBASE, Pubmed and Cochrane databases. Both clinical and experimental studies published in English from 1985 to August 2015 were included. The main outcome measure was the risk of anastomotic leakage and other postoperative complications during colorectal surgery. Determined risk factors of CAL were stated as strong evidence (level I and II high quality studies), and potential risk factors as either moderate evidence (experimental studies level III), or weak evidence (level IV or V studies). RESULTS The final analysis included 117 articles. Independent factors of CAL are diabetes mellitus, hyperglycemia and a high HbA1c, anemia, blood loss, blood transfusions, prolonged operating time, intraoperative events and contamination and a lack of antibiotics. Unequivocal are data on blood pressure, the use of inotropes/vasopressors, oxygen suppletion, type of analgesia and goal directed fluid therapy. No studies could be found identifying the impact of body core temperature or mean arterial pressure on CAL. Subjective factors such as the surgeons' own assessment of local perfusion and visibility of the operating field have not been the subject of relevant studies for occurrence in patients with CAL. CONCLUSION Both surgery related and non-surgery related risk factors that can be modified must be identified to improve colorectal care. Surgeons and anesthesiologists should cooperate on these items in their continuous effort to reduce the number of CAL. A registration study determining individual intraoperative risk factors of CAL is currently performed as a multicenter cohort study in the Netherlands.
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Affiliation(s)
- S J van Rooijen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands.
| | - D Huisman
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - M Stuijvenberg
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - J Stens
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - R M H Roumen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - F Daams
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - G D Slooter
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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Shah M, Ellis CT, Phillips MR, Marzinsky A, Adamson W, Weiner T, Erickson K, Lee S, Lange PA, McLean SE. Preoperative Bowel Preparation before Elective Bowel Resection or Ostomy Closure in the Pediatric Patient Population Has No Impact on Outcomes: A Prospective Randomized Study. Am Surg 2016; 82:801-806. [PMID: 27670567 PMCID: PMC5171233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The role of preoperative bowel prep in the pediatric surgical population is uncertain. We performed a randomized prospective study to evaluate noninferiority between the presence or absence of a preoperative bowel prep in elective pediatric bowel surgery on postoperative outcomes. Patients aged three months to 18 years were recruited and randomized to the bowel prep group or the no bowel prep group. Patients were evaluated in-hospital and at postoperative clinic visits. Thirty-two patients were recruited; 18 in the bowel prep group and 14 in the no bowel prep group. There was no statistical difference (P > 0.05) in complications between the groups. Complications were observed in five patients in each group (27.8% and 35.7%, respectively). In the bowel prep group, two (11.1%) had wound infection (vs three, 21.4%), 0 had an intra-abdominal abscess (vs one, 7.1%), one (5.6%) had sepsis (vs one, 7.1%), one (5.6%) had an anastomotic leak (vs 0), and three (16.7%) had a bowel obstruction (vs one, 7.1%). There were no extra-abdominal complications. There were no significant differences in complications between the two groups. Further research is warranted, but may require a multi-institutional trial to recruit sufficient numbers to make conclusions about the significance of the need for bowel prep.
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Affiliation(s)
- Mansi Shah
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Clayton T. Ellis
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Michael R. Phillips
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Amy Marzinsky
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - William Adamson
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Timothy Weiner
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Kimberly Erickson
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Sang Lee
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
| | - Patricia A. Lange
- Department of Surgery, Division of Pediatric Surgery, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Sean E. McLean
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC
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Affiliation(s)
- Alice Charlotte Adelaide Murray
- Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY 10032, USA
| | - Ravi P Kiran
- Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY 10032, USA.
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11
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Shah M, Ellis CT, Phillips MR, Marzinsky A, Adamson W, Weiner T, Erickson K, Lee S, Lange PA, McLean SE. Preoperative Bowel Preparation before Elective Bowel Resection or Ostomy Closure in the Pediatric Patient Population Has No Impact on Outcomes: A Prospective Randomized Study. Am Surg 2016. [DOI: 10.1177/000313481608200941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The role of preoperative bowel prep in the pediatric surgical population is uncertain. We performed a randomized prospective study to evaluate noninferiority between the presence or absence of a preoperative bowel prep in elective pediatric bowel surgery on postoperative outcomes. Patients aged three months to 18 years were recruited and randomized to the bowel prep group or the no bowel prep group. Patients were evaluated in-hospital and at postoperative clinic visits. Thirty-two patients were recruited; 18 in the bowel prep group and 14 in the no bowel prep group. There was no statistical difference ( P > 0.05) in complications between the groups. Complications were observed in five patients in each group (27.8% and 35.7%, respectively). In the bowel prep group, two (11.1%) had wound infection (vs three, 21.4%), 0 had an intra-abdominal abscess (vs one, 7.1%), one (5.6%) had sepsis (vs one, 7.1%), one (5.6%) had an anastomotic leak (vs 0), and three (16.7%) had a bowel obstruction (vs one, 7.1%). There were no extra-abdominal complications. There were no significant differences in complications between the two groups. Further research is warranted, but may require a multi-institutional trial to recruit sufficient numbers to make conclusions about the significance of the need for bowel prep.
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Affiliation(s)
- Mansi Shah
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Clayton T. Ellis
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Michael R. Phillips
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Marzinsky
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - William Adamson
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Timothy Weiner
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Kimberly Erickson
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Sang Lee
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Patricia A. Lange
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sean E. McLean
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, North Carolina
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12
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Kim YW, Kim IY. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Clin Interv Aging 2016; 11:689-97. [PMID: 27279741 PMCID: PMC4878661 DOI: 10.2147/cia.s104783] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69−14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8−9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13−8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07−18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43−9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15−6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44−8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39−14.09], P=0.012) were significant prognostic factors for 1-year mortality. Conclusion Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality.
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Affiliation(s)
- Young Wan Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ik Yong Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Piroglu I, Tulgar S, Thomas DT, Cakiroglu B, Piroglu MD, Bozkurt Y, Gergerli R, Ates NG. Mechanical Bowel Preparation Does Not Affect Anastomosis Healing in an Experimental Rat Model. Med Sci Monit 2016; 22:26-30. [PMID: 26725402 PMCID: PMC4706103 DOI: 10.12659/msm.895804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Mechanical bowel preparation before colorectal surgery is commonly performed, but its benefits are controversial. The aim of this study was to compare the effects of mechanical bowel preparation on healing of colonic anastomosis and tissue strength. Material/Methods After institutional review board approval, 20 adult Wistar albino rats were randomly divided into 2 groups of 10 animals each. Mechanical bowel preparation including sodium phosphate was performed on the experimental group via a feeding tube, whereas no bowel preparation procedures were performed on the control group. Transverse colon resection and anastomosis were performed on all rats under general anaesthesia. On postoperative day 5, re-laparotomy was performed and the anastomotic areas were resected. Animals were killed, after which bursting pressure and tissue hydroxyproline concentrations were measured, histopathological examination was performed, and we evaluated and compared the results. Results There were no differences between control and experimental groups in bursting pressure, tissue hydroxyproline concentrations, or histopathological examination results (P>0.05). Conclusions Our study demonstrated no significant difference between bursting pressures, tissue hydroxyproline levels, or modified wound healing score at postoperative day 5 between rats undergoing and not undergoing mechanical bowel preparation. Mechanical bowel preparation is not essential for healing or strength of colonic anastomosis in rats.
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Affiliation(s)
- Isılay Piroglu
- Department of General Surgery, Bitlis State Hospital, Bitlis, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology & Reanimation, Pendik State Hospital, Istanbul, Turkey
| | | | - Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | | | - Yasin Bozkurt
- Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey
| | - Ruken Gergerli
- Department of Anesthesiology & Reanimation, Karakocan State Hospital, Elazig, Turkey
| | - Nagihan Gozde Ates
- Department of Anesthesiology & Reanimation, Gumushane State Hospital, Gumushane, Turkey
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14
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Bhat AH, Parray FQ, Chowdri NA, Wani RA, Thakur N, Nazki S, Wani I. Mechanical bowel preparation versus no preparation in elective colorectal surgery: A prospective randomized study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Hohenberger H, Delahanty K. Patient-Centered Care—Enhanced Recovery After Surgery and Population Health Management. AORN J 2015; 102:578-83. [DOI: 10.1016/j.aorn.2015.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022]
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16
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Kim IY, Kim BR, Kim HS, Kim YW. Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. Onco Targets Ther 2015; 8:3441-8. [PMID: 26640384 PMCID: PMC4657796 DOI: 10.2147/ott.s93420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery. METHODS A total of 100 consecutive stage IV patients undergoing open (n=61) or laparoscopic (n=39) major resection were analyzed. There were four cases (10%) of conversion to laparotomy in the laparoscopy group. RESULTS Pathological T4 tumors (56% vs 26%), primary colon cancers (74% vs 51%), and larger tumor diameter (6 vs 5 cm) were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39%) and low anterior resection was more common in the laparoscopy group (39%, P=0.002). Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100%) than with open surgery (56%), although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups. CONCLUSION Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage IV patients, tumor factors such as primary rectal tumor, peritoneal carcinomatosis, or liver metastasis may not be absolute contraindications for a laparoscopic approach.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Bo Ra Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Young Wan Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
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Courtney DE, Kelly ME, Burke JP, Winter DC. Postoperative outcomes following mechanical bowel preparation before proctectomy: a meta-analysis. Colorectal Dis 2015; 17:862-9. [PMID: 26095870 DOI: 10.1111/codi.13026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/14/2015] [Indexed: 12/23/2022]
Abstract
AIM Previous meta-analyses of mechanical bowel preparation (MBP) before colorectal surgery have grouped colon and rectal resection together. An increased postoperative morbidity has been suggested in the absence of MBP following proctectomy. The current study used meta-analytical techniques to evaluate the comparative outcome of patients who received MBP prior to proctectomy. METHOD A comprehensive search was performed for published studies examining the effect of MBP before proctectomy on patient outcome. Random effects methods were used to combine data. RESULTS Eleven studies including 1258 patients were identified. There was no significant difference in overall morbidity (OR 1.062, 95% CI 0.584-1.933, P = 0.844), anastomotic leakage (OR 1.144, 95% CI 0.767-1.708, P = 0.509), surgical site infection (OR 0.946, 95% CI 0.549-1.498, P = 0.812) or mortality (OR 1.377, 95% CI 0.549-3.455, P = 0.495) between those who did not and those who did receive MBP prior to proctectomy. CONCLUSION The current study did not demonstrate a beneficial effect of MBP prior to proctectomy, but the data were limited. Decision-making as to its use should be made on a case-by-case basis.
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Affiliation(s)
- D E Courtney
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - M E Kelly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - J P Burke
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - D C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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Amouzeshi A, Amouzeshi Z, Naseh G, Vejdan SA, Tanha AS, Hosseinzadeh M, Vagharseyyedin SR. The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery. J Surg Res 2015; 199:322-5. [PMID: 25979561 DOI: 10.1016/j.jss.2015.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/13/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given the limited data on the need of mechanical bowel preparation application before anorectal surgeries and the preferred method for bowel preparation, we aimed to compare saline enema and bisacodyl in rectal preparation before anorectal surgery. MATERIALS AND METHODS This is a randomized clinical trial study. Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula) were recruited by convenient sampling and then randomly allocated to receive 500 cc Saline by rectal enema or six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel. After surgery, surgeons' satisfaction of the surgery and patients' satisfaction of the preparation process were evaluated in the ward using Likert score by a nurse blind to the study. Also, the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0-10 scores. All patients were actively followed-up after discharge for 1 mo concerning postoperative complications. The obtained data were analyzed by SPSS software (version 16), Mann-Whitney, chi-squared, and Fisher exact tests at the significant level of P < 0/0.5. RESULTS A total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets. No significant differences were observed between the two groups in most variables except for pain after the first defecation (P = 0.032). CONCLUSIONS According to the results, the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema. Thus, bisacodyl can be suggested as a superior counterpart for enema.
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Affiliation(s)
- Ahmad Amouzeshi
- Department of Cardiovascular Surgery, Surgery and Trauma Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Amouzeshi
- Surgery and Trauma Research Center, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.
| | - Ghodratollah Naseh
- Department of General Surgery, Surgery and Trauma Research Center, Birjand University of Medicine Sciences, Birjand, Iran
| | - Seyyed Amir Vejdan
- Department of General Surgery, Surgery and Trauma Research Center, Birjand University of Medicine Sciences, Birjand, Iran
| | - Amir Saber Tanha
- Department of Anesthesiology, Surgery and Trauma Research Center, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmood Hosseinzadeh
- Department of Cardiovascular Surgery, Surgery and Trauma Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Kim DH, Kim IY, Kim BR, Kim YW. Factors affecting the selection of minimally invasive surgery for stage 0/I colorectal cancer. Int J Surg 2015; 16:44-48. [PMID: 25749437 DOI: 10.1016/j.ijsu.2015.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate which factors affect selection of minimally invasive surgery (MIS) or open procedures for patients with stage 0/I colorectal cancer. The short-term and oncologic outcomes of MIS were also compared to those of open procedures. METHODS A total of 181 consecutive patients underwent either MIS (laparoscopy: n = 146, robot: n = 8) or open (n = 27) colorectal resection for stage 0/I disease. RESULTS Elderly patients (≥80) were more common in the open procedure group (22.2%) than the MIS (7.8%) group (p = .02). Surgeon A performed more MIS procedures than surgeon B (p = .003). There were no differences in the 30-day complication rate between open (37%) and MIS (21.4%) groups (p = .08). Time to tolerable diet (p = .002) and length of hospital stay (p = .02) were shorter in the MIS group. There were no differences in the cancer-specific survival (p = .71) and recurrence-free survival rates (p = .67) between open and MIS procedures. CONCLUSIONS Patient factors (old age) and surgeon factors (surgeon B) were barriers to the choice of MIS. Old age and operating surgeons were not associated with adverse 30-day complications. The short-term and oncologic outcomes of MIS were comparable to those of open procedures. It is safe to expand the indication for MIS to elderly patients.
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Affiliation(s)
- Dong Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ik Yong Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Bo Ra Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Wan Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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