Article

Which comorbid conditions predict complications after surgery for colorectal cancer?

Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), PO Box 231, 5600, AE, Eindhoven, The Netherlands.
World Journal of Surgery (Impact Factor: 2.23). 01/2007; 31(1):192-9. DOI: 10.1007/s00268-005-0711-8
Source: PubMed

ABSTRACT Accurate presurgical assessment is important to anticipate postoperative complications, especially in the growing proportion of elderly cancer patients. We designed a study to define which comorbid conditions at the time of diagnosis predict complications after surgery for colorectal cancer.
A random sample of 431 patients recorded in the population-based Eindhoven Cancer Registry who underwent resection for stage I-III colorectal cancer, newly diagnosed between 1995 and 1999 were entered into this study.
The influence of specific comorbid conditions on the incidence and type of complications after surgery for colorectal cancer was analyzed.
Overall, patients with comorbidity did not develop more surgical complications. However, patients with a tumor located in the colon who suffered from concomitant chronic obstructive pulmonary disease (COPD) more often developed pneumonia (18% versus 2%; P = 0.0002) and hemorrhage (9% versus 1%; P = 0.02). Patients with colon cancer who suffered from deep vein thrombosis (DVT) at the time of cancer diagnosis more often had surgical complications (67% versus 30%; P = 0.04), especially more minor infections (44% versus 11%; P = 0.002) and major infections (56% versus 10%; P < 0.0001), pneumonia (22% versus 2%; P = 0.01), and thromboembolic complications (11% versus 3%; P = 0.02). Patients with a tumor located in the rectum who suffered from COPD more frequently had any surgical complication (73% versus 46%; P = 0.04), and the presence of DVT at the time of cancer diagnosis was predictive of thromboembolic complications (17% versus 4%; P = 0.045). The presence of DVT remained significant after adjustment for relevant patient and tumor characteristics (odds ratio 9.0, 95% confidence interval 1.1-27.9).
Among patients undergoing surgery for colorectal cancer, development of complications was especially predicted by presence of COPD and DVT. In patients with the latter comorbidity, regulation of the pre- and postsurgical hemostatic balance needs full attention.

0 Bookmarks
 · 
136 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical resection with restoration of bowel continuity is the cornerstone of treatment for patients with colonic cancer. The aim of this study was to identify risk factors for anastomotic leakage (AL) and subsequent death after colonic cancer surgery. Data were retrieved from the Dutch Surgical Colorectal Audit. Patients undergoing colonic cancer resection with creation of an anastomosis between January 2009 to December 2011 were included. Outcomes were AL requiring reintervention and postoperative mortality following AL. AL occurred in 7·5 per cent of 15 667 patients. Multivariable analyses identified male sex, high American Society of Anesthesiologists (ASA) fitness grade, extensive tumour resection, emergency surgery, and surgical resection types such as transverse resection, left colectomy and subtotal colectomy as independent risk factors for AL. A defunctioning stoma was created in a small group of patients, leading to a lower risk of leakage. The mortality rate was 4·1 per cent overall, and was significantly higher in patients with AL than in those without leakage (16·4 versus 3·1 per cent; P < 0·001). Multivariable analyses identified older age, high ASA grade, high Charlson score and emergency surgery as independent risk factors for death after AL. The adjusted risk of death after AL was twice as high following right compared with left colectomy. The elderly and patients with co-morbidity have a higher risk of death after AL. Accurate preoperative patient selection, intensive postoperative surveillance for AL, and early and aggressive treatment of suspected leakage is important, especially in patients undergoing right colectomy.
    British Journal of Surgery 03/2014; 101(4):424-32. · 4.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Comanagement of surgical patients has increased, but information regarding detailed characteristics of patients receiving comanagement during hospitalization for colorectal cancer (CRC) surgery is lacking. To examine the use of and characteristics associated with comanagement of patients hospitalized for CRC surgery. This study used a population-based cross-sectional design. We used the linked 2000 to 2005 Surveillance, Epidemiology, and End Results and Medicare claims data. We included 37,065 patients aged 66 years or older, hospitalized for definitive CRC surgery following stage I to III diagnosis. The outcome of interest was comanagement during hospitalization for CRC surgery, and we examined the association between several patient and hospital characteristics. Comanagement was defined as having a relevant physician (ie, internal medicine hospitalist/generalist) submit a claim for evaluation and management services on 70% or more of the days of hospitalization of the patient. During hospitalization for CRC surgery, 27.6% of patients were comanaged, but this percentage varied widely across hospitals (from 1.9% to 83.2%). Several patient and hospital characteristics were associated with the use of comanaged care, of which important characteristics included older age at diagnosis, presence of comorbidity, emergency surgery, and hospital volume. Extensive variability existed in comanagement use across patients and hospitals, likely reflecting the lack of evidence for its clinical effectiveness. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine.
    Journal of Hospital Medicine 02/2014; · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mortality following severe complications (failure‐to‐rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon‐ and rectal cancer resections. Methods: Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011– 2012. Severe complication‐ and FTR rates were compared between the groups in univariate and multivariate analysis. Results: Colon cancer (CC) patients (n ¼ 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n ¼ 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06–3.37). Conclusions: Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non‐)surgical complications, especially in colon cancer surgery.
    Journal of Surgical Oncology 11/2013; · 2.64 Impact Factor

Full-text (2 Sources)

View
39 Downloads
Available from
May 22, 2014