Laparoscopic Radical Resection of Colorectal Cancer in the Treatment of Elderly Colorectal Cancer and Its Effect on Gastrointestinal Function

Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery

Objective

To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery.

Methods

Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration.

Results

The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction.

Conclusions

This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.

Analysis of the incidence and influencing factors of abdominal distension in postoperative lung cancer patients in ICU based on real-world data: a retrospective cohort study

BACKGROUND

Abdominal distension is a relatively common complication in postoperative lung cancer patients, which affects patients' early postoperative recovery to varying degrees. However, the current status of the incidence of abdominal distension in postoperative lung cancer patients and the affecting factors are not well understood. This study aims at exploring the incidence of abdominal distension in postoperative lung cancer patients in ICU based on real-world data and analyzing its influencing factors.

METHODS

A retrospective cohort study was conducted, encompassing patients who underwent lung cancer resections in the Lung Cancer Center of West China Hospital of Sichuan University from April 2020 to April 2021. Nevertheless, patients younger than 18 years and those whose information was limited in medical records were excluded. All data were obtained from the hospital HIS system. In this study, the influencing factors of abdominal distension were analyzed by univariate analysis and multiple logistic regression methods.

RESULTS

A total of 1317 patients met eligibility criteria, and were divided into the abdominal distended group and the non-distended group according to whether abdominal distension occurred after surgery. Abdominal distension occurred in a total of 182 cases(13.8%). The results of the univariate analysis showed that, compared with the non-distended group, the abdominal distended group had these features as follows: more women (P = 0.021), older (P = 0.000), lower BMI (P = 0.000), longer operation duration (P = 0.031), more patients with open thoracotomy (P = 0.000), more patients with pneumonectomy (p = 0.002), more patients with neoadjuvant chemotherapy (P = 0.000), more days of hospitalization on average (P = 0.000), and higher costs of hospitalization on average (P = 0.032). Multifactor logistic regression analysis showed that sex (OR = 0.526; 95% CI = 0.378 ~0.731), age (OR = 1.154; 95%CI = 1.022 ~1.304) and surgical approach (OR = 4.010; 95%CI = 2.781 ~5.781) were independent influencing factors for the occurrence of abdominal distension in patients after lung cancer surgery in ICU.

CONCLUSIONS

The incidence of abdominal distension was high in postoperative lung cancer patients in ICU, and female, older and patients with open thoracotomy were more likely to experience abdominal distension.

TRIAL REGISTRATION

The study was approved by the Chinese Clinical Trials Registry (registration number was ChiCTR2200061370).

Application of dexmedetomidine combined with ultrasound-guided transverse abdominal fascia block during radical colorectal cancer surgery under general anesthesia

BACKGROUND

Radical surgery is the main treatment for colorectal cancer, and effective anaesthesia is required in the perioperative period to ensure a smooth operation. Dexmedetomidine is a commonly used anaesthetic drug, but the optimal dose for general anaesthesia in radical colorectal cancer surgery is still unknown.

AIM

To investigate the application of different doses of dexmede-tomidine combined with ultrasound-guided transverse abdominal fascial block in radical colorectal cancer surgery under general anesthesia.

METHODS

Two hundred patients proposed for radical colorectal cancer surgery under general anesthesia at our hospital from October 2017 to September 2022 were selected and divided into three groups (A, B, and C) using the random number table method. Sixty-seven patients in group A were given 0.5 μg/kg dexmedetomidine, 67 patients in group B were given 0.25 μg/kg dexmedetomidine, and 66 patients in group C were given an equal dose of saline. The vital signs [heart rate (HR), oxygen saturation (SaO₂), and mean arterial pressure (MAP)] before induction of anesthesia (T0), after dexmedetomidine injection (T1), 1 h after the start of surgery (T2), and immediately after the end of surgery (T3), the visual analog scale (VAS) scores at 6 h, 12 h, and 24 h after surgery, the number of analgesic pump compressions at 24 h after surgery, the number of times of remedial analgesia, the levels of immune cytokines [tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), and interleukin-10 (IL-10)], serum neurotransmitter [serum S100B protein (S100B), serum neuron-specific enolase (NSE), and serum brain-derived neurotrophic factor (BDNF)] before surgery and 12 h and 24 h after surgery, and adverse effects were recorded.

RESULTS

There was no statistically significant difference in SaO₂ among the three groups from T0 to T3 (P > 0.05), and HR and MAP at T1 and T2 were lower in group A than in groups B and C, and in group B than in group C (P < 0.05). VAS scores in group A were lower than those in groups B and C at 6 h, 12 h, and 24 h postoperatively, and the number of analgesic pump compressions and times of remedial analgesia at 24 h postoperatively were less in group A than in groups B and C (P < 0.05), and in group B than in group C (P < 0.05). Serum TNF-α and IL-10 at 12 h and 24 h postoperatively were lower in group A than in groups B and C, and IL-2 was higher than in groups B and C; these indexes in group B were superior to those in group C (P < 0.05). Serum S100B and NSE at 12 h postoperatively were lower in group A than in groups B and C, and BDNF was higher than in groups B and C; these indexes in group B were superior to those in group C (P < 0.05). The differences in the incidence of adverse reactions were not statistically significant among the three groups (P > 0.05).

CONCLUSION

Compared with 0.25 μg/kg dexmedetomidine, 0.5 μg/kg dexmedetomidine combined with ultrasound-guided transverse abdominal fascial block for radical colorectal cancer surgery under general anesthesia can more effectively maintain the stability of patients' vital signs, with less impact on patients' immune function and neurological function, and better postoperative analgesia without increasing the risk of adverse effects.

Laparoscopic Radical Resection versus Routine Surgery for Colorectal Cancer

For patients with colorectal cancer, minimally invasive surgical methods, particularly laparoscopic methods, are now the preferred course of therapy. This research is performed to investigate the effects of laparoscopic radical resection on patients with colorectal cancer. A total of 100 colorectal cancer patients treated in our hospital from January 2017 to January 2019 were enrolled. The subjects were divided into observation (n = 50) and control (n = 50) groups and treated with laparoscopic surgery and laparotomy, respectively. As well as postoperative complications and survival rates, the levels of inflammatory substances, stress response, immunological function, and perioperative markers were compared between the two groups. There was no significant difference in the postoperative exhaust time between the two groups (P > 0.05). Compared with the control group, the observation group showed longer operation time, faster recovery of intestinal function, shorter hospital stay, and less intraoperative bleeding amount (P < 0.05). The serum contents of hs-CRP, TNF-α, IL-6, norepinephrine, adrenaline, and cortisol at 1 d, 3 d, and 5 d after surgery were significantly higher than before in both groups (P < 0.05). Moreover, the serum contents of hs-CRP, TNF-α, IL-6, norepinephrine, adrenaline, and cortisol in the observation group were significantly lower than that in the control group (P < 0.05). At 10 days following surgery, immune index levels had dramatically increased in both groups, with noticeably higher immune index levels in the observation group than in the control group (P < 0.05). There were no appreciable differences in the two groups' 2-year survival rates (P > 0.05), but the complication rate was much greater in the control group (P < 0.05). To sum up, after laparoscopic surgery, patients had fewer complications, shorter hospital stay, lower inflammatory factor expression, less stress response, better immune function, less trauma, faster recovery, and improved quality of life.