Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

AIM

This study aims to describe the nature, incidence, severity and outcomes of in-hospital postoperative complications (POCs) in older patients undergoing elective surgery for colorectal cancer.

METHOD

Patients ≥ 70 years old were identified from a prospectively collected database (2009-2015) focusing on the implementation of geriatric screening and assessment in patients with cancer. Medical and surgical POCs were retrieved retrospectively from the medical records, and the severity of the POCs was graded by the Clavien-Dindo (CD) grading system. The following outcomes were analysed comparing patients with and without CD ≥ 2 and CD ≥ 3 POCs: length of stay (LOS), transfer to the intensive care unit, 30-day readmission rates, 30-day and 1-year mortality.

RESULTS

In the 190 patients included, medical POCs (40.5%) were more frequent than surgical POCs (17.9%), and 37.9% experienced CD ≥ 2 POCs. The most common medical POCs were infections (26.8%), transient confusion or altered mental function (12.1%), cardiac arrhythmia (4.7%), and ileus/gastroparesis/prolonged recovery of transit (4.7%). The most common surgical POCs were surgical site infections (12.1%), wound dehiscence/bleeding (4.7%), anastomotic leak (3.7%) and surgical site bleeding (3.7%). The reoperation rate was 7.9%. CD ≥ 2 POCs led to 11 intensive care unit admissions and increased median postoperative LOS by 114% (P < 0.0001 for both), but did not significantly alter 30-day readmission and 30-day and 1-year mortality rates. CD ≥ 3 POCs increased LOS by 162% (P < 0.0001) and showed an increased 1-year mortality (P = 0.07).

CONCLUSION

This study shows that in-hospital medical and surgical complications after surgery for colorectal cancer in patients ≥ 70 years old are frequent and that complications lead to less favourable outcomes.

Severe alopecia due to demodicosis in roe deer (Capreolus capreolus) in Belgium

Demodex mites are part of the normal fauna of hair follicles of many, if not all, healthy mammal species. Normally these parasites live in harmony with their host, however in states of putative immunosuppression the acarids undergo excessive proliferation and cause clinical disease, which may be localised or generalised. This paper describes four cases of demodicosis in roe deer (Capreolus capreolus) with localised to generalised alopecia.

First chronic wasting disease (CWD) surveillance of roe deer (Capreolus capreolus) in the northern part of Belgium

Cases of chronic wasting disease (CWD) in wild cervids have yet not been reported in Europe, whereas the disease is considered enzootic in free-ranging mule deer, Rocky mountain elk and white-tailed deer in the area of Colorado, Wyoming, and Nebraska. New foci of CWD continue to be detected in other parts of the United States. However, no large-scale active epidemiosurveillance of European wild cervids is yet installed in Europe. In accordance with the opinion of the European Scientific Steering Committee, a preliminary (active) surveillance scheme was installed, in order to improve the knowledge of the CWD status of wild cervids (roe deer) in the Northern part of Belgium. Spleen samples (n=206) and brain samples (n=222) of roe deer collected in the Northern part of Belgium, were examined for CWD using the antigen-capture enzyme-linked immunoassay (EIA) of IDEXX. Afterwards, the EIA was systematically confirmed by immunohistochemistry using three antibodies, namely R524, 2G11 and 12F10. There were no indications on the occurrence of TSE in any of the samples. A Bayesian framework was used for the estimation of the true prevalence of CWD in the Northern part of Belgium that was estimated to have a median value of zero with a 95th percentile value of 0.0049 and 0.0045 for spleen and brain samples respectively.

[A case of mesenteric venous thrombosis. Review of the literature]

A case is presented in which a venous mesenteric thrombosis necessitated an extended small bowel resection. The postoperative follow-up with its complications is presented. Review of the literature.