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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.
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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
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Matallana C, Pera M, Espin-Basany E, Biondo S, Badia JM, Limon E, Pujol M, de Lacy B, Aliste L, Borràs JM, Manchon-Walsh P. Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme. World J Surg Oncol 2024; 22:138. [PMID: 38789966 PMCID: PMC11127316 DOI: 10.1186/s12957-024-03410-9] [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: 04/03/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery. METHODS The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen's kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated. RESULTS Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients-235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65-0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat. CONCLUSIONS This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection. CLINICALTRIALS gov Identifier: NCT06104579. Registered 30 November 2023.
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Affiliation(s)
- Carlota Matallana
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
- Department of General and Digestive Surgery, Hospital del Mar, Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Miguel Pera
- Department of General and Digestive Surgery Department, Institute of Digestive and Metabolic Diseases (ICMDM), Biomedical Research Centre (CIBERehd), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Pº de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Badia
- Department of Surgery, Hospital General de Granollers, Av Francesc Ribas 1, Barcelona, 08402, Granollers, Spain.
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Enric Limon
- Departament de Salut, VINCat Programme - Surveillance of Healthcare Related Infections in Catalonia, Barcelona, Spain
- Department of Public Health, Mental Health and Mother-Infant Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Miquel Pujol
- Departament de Salut, VINCat Programme - Surveillance of Healthcare Related Infections in Catalonia, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Borja de Lacy
- Department of General and Digestive Surgery Department, Institute of Digestive and Metabolic Diseases (ICMDM), Biomedical Research Centre (CIBERehd), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Luisa Aliste
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Borràs
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Manchon-Walsh
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Ushimaru Y, Nagano S, Kawabata R, Nishikawa K, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imasato M, Noura S, Miyamoto A. Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support. World J Surg Oncol 2024; 22:136. [PMID: 38778314 PMCID: PMC11112811 DOI: 10.1186/s12957-024-03421-6] [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: 03/27/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND As the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients. METHODS A retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes. RESULTS Among 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications. CONCLUSION Implementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinnosuke Nagano
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Sakae Maeda
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
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Tamai K, Hirose H, Okamura S, Akazawa Y, Koh M, Hayashi K, Katsura Y, Tanaka N, Ebisui C, Yano M. Prognostic Value of C-reactive Protein-to-albumin Ratio after Curative Resection in Patients with Colorectal Cancer. J Anus Rectum Colon 2023; 7:273-283. [PMID: 37900690 PMCID: PMC10600269 DOI: 10.23922/jarc.2023-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives The current retrospective study aimed to evaluate the association between combined preoperative and postoperative C-reactive protein-to-albumin ratio, which is correlated with prognosis in different types of malignancies, and prognosis after curative resection in patients with colorectal cancer. Methods This study enrolled 263 patients who underwent curative resection for stage II/III colorectal cancer. C-reactive protein-to-albumin ratio was calculated within 30 days before and 7 days after surgery. Receiver operating characteristic curve analyses were performed to determine the optimal cutoff values of preoperative and postoperative C-reactive protein-to-albumin ratio. The correlations between combined preoperative and postoperative C-reactive protein-to-albumin ratio and prognosis were analyzed. Results The cutoff values of preoperative and postoperative C-reactive protein-to-albumin ratio were 0.223 and 0.813, respectively; higher ratios were significantly associated with poor overall survival, based on the Kaplan-Meier curves (p < 0.001, p = 0.003, respectively). Further, preoperative and postoperative C-reactive protein-to-albumin ratios were correlated with poor progression-free survival (p < 0.001, p = 0.064, respectively). In the multivariate analysis, combined preoperative and postoperative C-reactive protein-to-albumin ratio was an independent predictor of overall survival and progression-free survival (p = 0.012, p = 0.044, respectively). Compared with low preoperative and postoperative C-reactive protein-to-albumin ratio, high ratios of that were significantly associated with poor overall survival (hazard ratio = 3.897, p = 0.006) and progression-free survival (hazard ratio = 2.130, p = 0.029). Conclusions Combined preoperative and postoperative C-reactive protein-to-albumin ratio, useful for prognostic prediction, can be a promising prognostic marker after curative resection in patients with colorectal cancer.
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Affiliation(s)
- Koki Tamai
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Hajime Hirose
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Yo Akazawa
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Masahiro Koh
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Koji Hayashi
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | | | - Natsumi Tanaka
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Chikara Ebisui
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
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Tang G, Pi F, Qiu YH, Wei ZQ. Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study. Front Nutr 2023; 10:1040893. [PMID: 37006941 PMCID: PMC10060866 DOI: 10.3389/fnut.2023.1040893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionThe clinical utility of glutamine in patients undergoing colorectal cancer (CRC) surgery remains unclear. Therefore, we aimed to investigate the impact of postoperative treatment with glutamine on postoperative outcomes in patients undergoing CRC surgery.MethodsWe included patients with CRC undergoing elective surgery between January 2014 and January 2021. Patients were divided into the glutamine and control groups. We retrospectively analyzed postoperative infections complications within 30 days and other outcomes using propensity score matching and performed between-group comparisons.ResultsWe included 1,004 patients who underwent CRC surgeries; among them, 660 received parenteral glutamine supplementation. After matching, there were 342 patients in each group. The overall incidence of postoperative complications was 14.9 and 36.8% in the glutamine and control groups, respectively, indicating that glutamine significantly reduced the incidence of postoperative complications [p < 0.001; risk ratio (RR) 0.41 [95% CI 0.30–0.54]]. Compared with the control group, the glutamine group had a significantly lower postoperative infection complications rate (10.5 vs. 28.9%; p < 0.001; RR 0.36 [95% CI 0.26–0.52]). Although there was no significant between-group difference in the time to first fluid diet (p = 0.052), the time to first defecation (p < 0.001), first exhaust (p < 0.001), and first solid diet (p < 0.001), as well as hospital stay (p < 0.001) were significantly shorter in the glutamine group than in the control group. Furthermore, glutamine supplementation significantly reduced the incidence of postoperative intestinal obstruction (p = 0.046). Moreover, glutamine supplementation alleviated the decrease in albumin (p < 0.001), total protein (p < 0.001), and prealbumin levels (p < 0.001).ConclusionsTaken together, postoperative parenteral glutamine supplementation can effectively reduce the incidence of postoperative complications, promote the recovery of intestinal function, and improve albumin levels in patients undergoing CRC surgery.
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Zhang X, Yang Z, Meng C, Gao J, Liu Y, Shi B, Sun L, Wu G, Yao H, Zhang Z. Abdomen anatomic characteristics on CT scans as predictive markers for short-term complications following radical resection of colorectal cancer. Front Surg 2022; 9:899179. [PMID: 35923439 PMCID: PMC9339639 DOI: 10.3389/fsurg.2022.899179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundPrediction and management of short-term postoperative complications in patients with colorectal cancer are essential in postoperative rehabilitation. Through CT scan images, we can easily measure some parameters of abdomen anatomic characteristics. This study aimed to assess whether there is a relationship between the abdomen anatomic characteristics and short-term postoperative complications.Materials and methodsWe conducted a retrospective study. Eighty patients in each complication group and non-complication group were recruited with propensity score match. Demographics, perioperative laboratory results and surgical information were collected and compared between groups with univariate analysis. Significant elements were brought into subsequent logistic regression analysis and ROC analysis for further identification.ResultsUnivariate analysis showed that preoperative white blood cells, preoperative neutrophil counts, rectus abdominis thickness (RAT), subcutaneous fat thickness (SFT), and abdomen depth (AD) were significantly different between the complication group and non-complication group. Logistic regression analysis demonstrated that higher RAT (p = 0.002), SFT (p < 0.001) and AD (p < 0.001) independently predicted the incidence of short-term postoperative complications.ConclusionsIn this study on patients undergoing radical resection of colorectal cancer, abdomen anatomic characteristics including higher RAT, SFT and AD are associated with an increased risk of short-term postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Guocong Wu
- Correspondence: Guocong Wu Hongwei Yao Zhongtao Zhang
| | - Hongwei Yao
- Correspondence: Guocong Wu Hongwei Yao Zhongtao Zhang
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