Surgery In Colorectal Cancer Patients Research Articles

Natural Killer Cell IFN\u03b3 Secretion is Profoundly Suppressed Following Colorectal Cancer Surgery

BackgroundSurgical stress results in a significant reduction in natural killer (NK) cell cytotoxicity (NKC), which has been linked to postoperative cancer metastases. However, few studies have measured the impact of surgical stress upon NK cell IFNγ secretion (NKA), a cytokine with essential roles in controlling infection and metastases. The objective of this study was to investigate the impact of surgical stress on NKA in colorectal cancer (CRC) surgery patients.MethodsPeripheral blood was collected from CRC surgery patients (n = 42) preoperatively and on postoperative day (POD) 1, 3, 5, 28, and 56. Healthy donor blood (n = 27) was collected for controls. We assessed NKA by production of IFNγ following whole blood cytokine stimulation, NKC by 51Cr-release assay, and immune cell profiling by flow cytometry.ResultsThe mean reduction in NKA on POD1 compared with baseline was 83.1% (standard deviation 25.2%; confidence interval 75–91), and therefore the study met the primary endpoint of demonstrating a > 75% decrease in a cohort of CRC surgery patients (p < 0.0001). The profound and universal suppression of NKA persisted with 65.5% (19/29) and 33.3% (4/12) of patients with levels measuring < 75% of baseline on POD28 and POD56 respectively. The NKC was significantly reduced on POD1, but the degree was less pronounced (24.6%, p = 0.0024). Immune cell profiling did not reveal differences in the absolute number of NK cells (CD3−CD56+) or the ratio of CD56dim-to-CD56bright subsets.ConclusionsNKA is significantly suppressed for up to two months following surgery in CRC patients, a degree of surgery-induced immunosuppression far worse than previously reported.

The dark side of laparoscopic surgery for colorectal cancer patients aged 75years or older.

The rate of postoperative morbidity and mortality is reportedly high in patients aged ≥ 75years with colorectal cancer (CRC). In such patients, a comparison of the short-term outcome between open method and laparoscopy has not been clearly defined in Taiwan. We aimed to compare postoperative morbidity and mortality parameters after open method and laparoscopy in CRC patients aged ≥ 75years. We retrospectively analyzed patients who underwent surgery for CRC from February 2009 to September 2015 at the Linkou Chang Gung Memorial Hospital in Taiwan and analyzed their clinicopathological factors. Postoperative morbidity and mortality were analyzed for evaluating if laparoscopic surgery offers more favorable outcomes than open surgery in the elderly. A total of 1133 patients were enrolled and analyzed in this study; they were divided into two groups (open method vs. laparoscopy = 797 vs. 336). The anastomotic leakage rate was significantly higher in the laparoscopy group than in the open method group (3.3 vs. 0.9%, p = 0.003). Overall postoperative morbidity and mortality rates showed no significant difference between these two groups. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open method group (10.4 ± 8.7 vs. 13.8 ± 13.5days, p < 0.001). Our results suggest that laparoscopy in patients aged ≥ 75years with CRC had higher anastomosis leakage rate compared with open surgery but is acceptable and offers the benefit of a shorter hospital stay over open surgery.

The impact of hereditary thrombophilia on the incidence of postoperative venous thromboembolism in colorectal cancer patients: a prospective cohort study

Hereditary thrombophilia may play an important role in the rate of postoperative venous thromboembolism (VTE). We focused on the impact of hereditary thrombophilia on VTE incidence in colorectal cancer surgery patients within a 1-year postoperative period. Preoperatively, identifying of colorectal cancer patients with thrombotic mutations (PTM+) and without thrombotic mutations (PTM−) was performed by screening of factor V Leiden (FVL) and prothrombin G20210A mutation. Within prophylactic period (0–28 days postoperatively), coagulation markers (platelets, fibrinogen, D‑dimer) were measured and symptomatic VTE was observed. Within post-prophylactic period (2–12 months after surgery), symptomatic VTE was observed. In all, 202 patients were assessed and hereditary thrombophilia was detected in 9.9% (FVL 8.4%; prothrombin G20210A mutation 1.5%). In the prophylactic period, VTE incidence in PTM+ and PTM− was 0.0% and 1.6%, respectively (p = 0.730). Levels of coagulation markers were comparable in both patient cohorts within 28 days postoperatively. In the post-prophylactic period, VTE incidence in PTM+ and PTM− was 15.0% and 5.5%, respectively (p = 0.125), and detailed incidence of deep vein thrombosis (DVT) in PTM+ and PTM− was 15.0% and 3.3%, respectively (p = 0.048). We observed significantly increased incidence of lower extremity DVT in such patients with FVL (17.6%). The standard regimen of extended-duration VTE prophylaxis is adequate for colorectal cancer patients with thrombotic mutations and more intensified VTE prophylaxis within the 28-day postoperative period is not justified. However, the ongoing postoperative pharmacologic prophylaxis (>28 days) should be considered in patients with hereditary thrombophilia, especially with FVL.

Safety of Laparoscopic Surgery for Colorectal Cancer in Patients with Severe Comorbidities.

Previous studies have shown that laparoscopic colorectal cancer surgery is highly safe and effective compared to laparotomy. However, whether laparoscopic colorectal cancer surgery can be safely performed in patients with severe comorbidities remains unclear. The aim of this study was to evaluate the safety of laparoscopic colorectal cancer surgery in patients with severe comorbidities. A total of 82 consecutive patients with colorectal cancer who underwent laparoscopic surgery were retrospectively divided into two groups according to whether they had severe comorbidity (50 patients) or non-severe comorbidity (32 patients). An age-adjusted Charlson comorbidity index of ≥6 was defined as severe comorbidity. Operative time, blood loss, and rate of conversion to laparotomy did not differ between the groups. Postoperative complications and the length of the postoperative hospital stay also did not differ significantly between the groups. Laparoscopic colorectal cancer surgery is feasible and safe, even in patients with severe comorbidities.

Development of risk assessment tool for unplanned readmission within one year after colorectal cancer surgery in patients under enhanced recovery after surgery mode

Objective To construct a risk assessment tool of unplanned readmission within 1 year after colorectal cancer surgery in patients under enhanced recovery after surgery (ERAS) mode. Methods A total of 446 patients who were treated in Gastrointestinal Surgery Department of West China Hospital and had been followed up for one year from January 2010 to May 2013 were selected as the research subjects by purposive sampling method. Logistic regression was adopted to analyze the influencing factors of unplanned readmission in colorectal cancer patients under ERAS. Through literature review and retrospective case control study, the risk assessment index of unplanned readmission for 1 year after colorectal cancer surgery in ERAS mode was drawn up, and the index selection and weight assignment were carried out by Delphi expert consultation method. Results The result of Logistic regression analysis showed that complications before first admission was the influencing factor of unplanned readmission in colorectal patients under ERAS (OR=2.91) . The recovery rates of the two rounds of expert consultation were 100%, the expert authority coefficient was 0.91, and the expert consultation coordination coefficient was 0.361 (χ2=32.711, P<0.001) . Four items of risk assessment indexes were established after two rounds of expert consultation, including: complications before surgery, emergency admission, advanced age and postoperative abnormalities. Conclusions The risk assessment tool for unplanned readmission within one year after colorectal cancer surgery in patients under ERAS mode was constructed with high reliability. It can be used to assess the unplanned readmission risk of patients with colorectal cancer, but its clinical applicability needs to be further verified. Key words: Colorectal neoplasms; Enhanced recovery after surgery; Unplanned readmission; Risk assessment; Delphi method

Signature consist of nine differentially methylated gene pairs to predict the prognosis for stage II colorectal cancer patients

// Li Zeng 1 , Kaixue Li 1 , Hong Wei 1 , Jingjing Hu 1 , Lu Jiao 1 , Juan Zhang 1 and Ying Xiong 1 1 Department of Gastroenterology, The Second People&rsquo;s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China Correspondence to: Ying Xiong, email: yxiongmed@hotmail.com Keywords: colorectal cancer; epigenetic; gene methylation; prognosis Received: August 22, 2017&emsp;&emsp;&emsp;&emsp; Accepted: November 13, 2017&emsp;&emsp;&emsp;&emsp; Published: January 05, 2018 ABSTRACT Colorectal cancer (CRC) is the third most commonly malignance cancer worldwide. The quality of life and life expectancy of CRC survivors are seriously impacted by the recurrence after resection surgery. Therefore, there is a need to develop a reliable signature to predict the recurrence after resection surgery in CRC patients. Epigenetic alterations, especially gene methylation, have been found highly related to the metastasis of tumors. However, limited evidence is available for CRC patients. Moreover, there remains a knowledge gap of a comprehensive view of gene methylation in stage II CRC. In this study, we conducted and validated a differentially methylated 9-gene-pair prognosis signature to predict recurrence after resection surgery in stage II CRC patients. In addition, we use Univariable and Multivariable Cox regression to estimate the association between relapse free survival times in relation to each candidate gene pairs and the 9-gene-pair score. Moreover, the network analysis found 8 hub genes, including NDRG4 and BMP3 , out of all candidate genes have large degree of interactions in the protein-protein interaction network. Seven hub genes have been found associated with CRC progression. Furthermore, the function enrichment analysis suggested that differentially methylated genes were mostly enriched in the cell cycle pathway. In summary, a 9-gene-pair signature was developed and validated in this study. The signatures identified in this study have the potential to be applied in the prognosis of post-surgery recurrence in the stage II CRC patents.

The Effect of Anesthesia on the Immune System in Colorectal Cancer Patients.

Colorectal cancer (CRC) is the key leading cause of high morbidity and mortality worldwide. Surgical excision is the most effective treatment for CRC. However, stress caused by surgery response can destroy the body's immunity and increase the likelihood of cancer dissemination and metastasis. Anesthesia is an effective way to control the stress response, and recent basic and clinical research has shown that anesthesia and related drugs can directly or indirectly affect the immune system of colorectal cancer patients during the perioperative period. Thus, these drugs may affect the prognosis of CRC surgery patients. This review is intended to summarize currently available data regarding the effects of anesthetics and related drugs on perioperative immune function and postoperative recurrence and metastasis in CRC patients. Determining the most suitable anesthesia for patients with CRC is of utmost importance.

Laparoscopic Colorectal Surgery in Patients With Previous Abdominal Surgery: A Single-center Experience and Literature Review.

To present the outcomes of laparoscopic colorectal surgery in colorectal cancer patients with a previous history of abdominal surgery. Data of a total of 121 patients with primary colorectal cancer who underwent laparoscopic surgery were retrospectively analyzed. The patients were divided into 2 groups as those with previous abdominal surgery (PAS, n=34) and those without (non-PAS, n=87). Gastric and colonic surgeries were the most common procedures in the major PAS group, whereas gynecologic and obstetric surgeries and appendectomy were the most common procedures in the minor PAS group. However, there were statistically significant differences in the overall complication rates, wound complications, and anastomotic leaks, although there were no significant differences in the rates of postoperative ileus, pneumonia, port site herniation, and postoperative bleeding between the groups. Our study results suggest that laparoscopic colorectal surgery can be safely performed in patients with colorectal cancer who underwent abdominal surgery previously.

Cost Savings of Perioperative Anemia Treatment with Ferric Carboxymaltose In Colorectal Cancer Surgery Patients

Pre-operative anemia, commonly associated with iron deficiency (IDA), occurs in approximately 30% of patients undergoing surgery. Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce the need for red blood cell concentrate (RBC), surgical complications, mortality and the hospital length of stay (LOS) in patients with preoperative IDA. The objective of this study is to model the cost impact of peri-operative IDA treatment with FCM vs. usual care prior to colorectal cancer surgery in the French health care setting. The model used is based on the results of a RCT by Froessler et al. comparing FCM vs. usual care in abdominal surgery mostly colorectal cancer surgery patients (73% in FCM group and 85% in usual care group). Reported reduction in RBC transfusion (12.5% vs. 31.5%) and LOS (6 days vs. 9) were used as clinical metrics of the model. Cost parameters for hospitalization are based on the French Diagnostic-Related Groups (DRG) and for hospital activity on the French national hospitalizations database (PMSI). DRG were identified based on the CIM-10 diagnosis for colorectal cancer (C18). The study sample was extrapolated to a cohort size of 100 patients. The model was adapted to a Health Insurance perspective. One-way sensitivity analyses (OWSA) were undertaken. A total of 20 485 hospital stays for CRC resection were extracted from the PMSI database. Results from the model suggests that peri-operative IDA treatment with FCM reduces the overall costs in a cohort of 100 patients from € 570,373 to € 426,358, corresponding to potential savings of €144,015. Sensitivity analysis showed that LOS and cost per day in hospital ward were the main cost drivers. Peri-operative IDA treatment with FCM in CRC surgery could lead to significant cost savings based on a reduction in blood transfusion and length of stay.

Estimation of Physiologic Ability and Surgical Stress Scoring System Could Provide Preoperative Advice on Whether to Undergo Laparoscopic Surgery for Colorectal Cancer Patients with High Physiological Risk: A Single Center Experience

Estimation of Physiologic Ability and Surgical Stress Scoring System Could Provide Preoperative Advice on Whether to Undergo Laparoscopic Surgery for Colorectal Cancer Patients with High Physiological Risk: A Single Center Experience

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk.

Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status.In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status.E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries.The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk.

Patients' Vulnerability in Follow-up After Colorectal Cancer: A Qualitative Action Research Study.

In the transition between being a hospitalized patient with cancer and resuming "normal" life, many patients experience physical, mental, and social challenges. Scientifically, as well as politically, it is therefore recommended to undertake research with a focus on rethinking and reorganizing follow-up after cancer treatment. The aim of this study was to identify the perspectives of fast-track colorectal cancer surgery patients on challenges experienced in the transition from being a hospitalized patient with cancer to being a cancer survivor. The current article represents phase 1 in an ongoing action research project. Data were analyzed by using the "interpretive description" method. Twelve patients (6 male and 6 female patients; mean age, 72.4 years) participated in the study. The analyses show that the patients physically experienced readiness to leave hospital after a few days; however, shortly after returning home, most of them became mentally overwhelmed by the feeling of vulnerability that was closely related to the feeling of being handed over the responsibility for a newly cancer-operated body and a fragile life situation. Four issues that challenged the patients emerged from the analysis: restore an everyday life, participate in a follow-up program, get relevant information, and manage contact with relevant health professionals. The study indicates that the transition to restoring a normal life after cancer surgery had been an experience characterized by more vulnerability than expected by the patients in the study. The findings provide 4 well-defined themes, each of which constitutes a point of departure related to focused patient-centered interventions related to follow-up after cancer surgery.

Karyopherin alpha 2 expression is a novel diagnostic and prognostic factor for colorectal cancer.

Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer-associated mortality in Western countries. CRC treatment is dependent on the preoperative and postoperative condition of patients. At present, the prognostic value of conventional parameters for the estimation of patient prognosis is limited. The aim of the present study was to investigate the expression of karyopherin α2 (KPNA2) in cancerous and healthy colon tissues and to evaluate the prognostic factors for patients with primary CRC. KPNA2 expression in CRC and paired normal tissues was analyzed by immunohistochemistry and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In addition, serum KPNA2 expression was evaluated by enzyme-linked immunosorbent assay. Subsequently, the association between KPNA2 expression in CRC tissues and patient clinicopathological features was analyzed. Kaplan-Meier analysis was utilized to investigate the prognostic value of KPNA2 expression on overall survival rates following radical surgery for the treatment of CRC. Immunohistochemistry and RT-qPCR revealed that KPNA2 expression was significantly increased in CRC tissues compared with paired normal tissues. Serum KPNA2 expression was significantly increased in CRC patients compared with healthy individuals. Furthermore, KPNA2 expression was observed to positively correlate with Tumor-Node-Metastasis stage, lymph node involvement, tumor differentiation, infiltration depth, lymphovascular invasion and perineural invasion, which are factors known to affect the prognosis of CRC patients following surgery. In addition, increased KPNA2 expression was associated with decreased overall survival and disease-free survival rates. Patients not suited for surveillance regimens may be identified at initial biopsy test with a positive KPNA2 immunohistochemistry. Increased serum expression of KPNA2 may be utilized as a diagnostic factor for patients with CRC. High nuclear KPNA2 expression may serve as a novel predictor of survival following radical colorectal surgery in CRC patients. The results of the present study may improve individualized risk stratification, leading to the optimization of therapies for CRC patients.

The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients.

There are approximately 1.3 million patients in Australia with diabetes. Conflicting reports exist in the literature as to the effect of diabetes on the outcomes of colorectal cancer patients. We hypothesized that patients with diabetes would have poorer perioperative outcomes, and that diabetes was an independent risk factor for both 30-day mortality and perioperative morbidity. The aim of this study was to assess the impact of diabetes on perioperative colorectal cancer surgery outcomes, as compared to a diabetes-free reference population, and to examine factors affecting perioperative risk. We conducted an analysis of a prospectively collected, clinician-led colorectal cancer database of patients from 2010–2015. Patients with diabetes were compared to patients without diabetes on a range of perioperative outcomes. Pearson χ-squared tests, Wilcoxon rank sum tests and t-tests were employed for univariate analyses. Confounding factors were controlled for by separate logistic and linear regression analyses. The Huber-White Sandwich Estimator was used to calculate robust standard errors. A total of 1725 patients were analysed over 1745 treatment episodes in the study period with 267 patients (268 episodes) with diabetes studied. Diabetes contributed to medical, surgical complications, and increased length of inpatient stay in univariate analyses. Multivariable analysis adjusted for variables independently associated with each outcome revealed that diabetes was an independent contributor to an increased risk of surgical complications, with no significant effect on medical complications, return to the operating room, 30-day mortality, or readmission within 30 days. In this study, where overall baseline morbidity and mortality levels are low, the effect of diabetes alone on perioperative surgical outcomes appears to be overstated with control of associated perioperative risk factors such as cardiac, renal and respiratory factors being more important.

Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ)

ObjectiveThe Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients’ knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness. MethodsElective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n=250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters. ResultsThe psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery. ConclusionThe adapted version of the PCSQ can be used for longitudinal analyses. Practice implicationsThe measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.

Is previous abdominal surgery still a contraindication for laparoscopic surgery in colorectal cancer patients

Laparoscopy emerged as an alternative surgical approach after the introduction of laparoscopic cholecystectomy in 1987, although certain conditions such as previous abdominal surgery (PAS) were considered as absolute contraindications for this technique.

Acupuncture for recovery after surgery in patients undergoing colorectal cancer resection: a systematic review and meta-analysis.

To assess the efficacy/effectiveness and safety of acupuncture in patients recovering from colorectal cancer resection. We systematically searched four English language databases (Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and AMED (Allied and Complementary Medicine Database)) and one Chinese database (CAJ, China Academic Journals). Randomised trials of acupuncture compared with usual/routine care, sham interventions or active comparators in patients undergoing colorectal cancer resection were eligible for inclusion. Postoperative symptoms and quality of life (QoL) were the primary outcomes for the review. Of 1225 screened hits, seven randomised trials with 540 participants were included. High or uncertain risk of bias and significant heterogeneity were observed. All outcomes were measured before discharge, and no trial explicitly reported post-discharge outcomes. The response to acupuncture in terms of postoperative symptoms was inconsistent across trials. QoL was not measured in the included studies. For certain outcomes reflecting physiological recovery, favourable effects of acupuncture were observed compared with sham acupuncture, namely time to first flatus (n=207, three studies; mean difference (MD) -7.48 h, 95% CI -14.58 to -0.39 h, I(2)=0%) and time to first defaecation (n=149, two studies; MD -18.04 h, 95% CI -31.90 to -4.19 h, I(2)=0%). Two studies reported there were no acupuncture-related adverse events, whereas the remaining studies did not consider adverse events. We found low-to moderate-quality evidence for the efficacy and safety of acupuncture for recovery after surgery in colorectal cancer patients. Future trials with adequate allocation concealment, blinding of outcome assessors, and measurement of post-discharge outcomes including QoL or functional recovery are warranted. CRD42014015537.

Laparoscopic surgery for colorectal cancer patients who underwent previous abdominal surgery.

Laparoscopic colorectal surgery may be impeded by intraperitoneal adhesions caused by previous abdominal surgery. The aim of this study was to determine the effect of previous abdominal surgery on short- and long-term outcomes of laparoscopic colorectal surgery. We retrospectively reviewed 3188 patients with primary colorectal cancer who underwent laparoscopic colorectal surgery between January 2004 and December 2013. Patients with a history of abdominal surgery (n=593, 18.6%) were compared to those without such history (n=2595, 81.4%). Patients who had undergone previous abdominal surgery exhibited acceptable intraoperative outcomes, including conversion to open surgery, operative time, estimated blood loss, and the number of harvested lymph nodes. Overall, postoperative complication rates were similar between the groups (10.8 vs. 10.6%, p=0.885). Subgroup analysis revealed that patients with history of major abdominal surgery (n=165) had higher rates of conversion to open surgery (4.2 vs. 1.7%, p=0.033), prolonged postoperative ileus (5.5 vs. 2.0%, p=0.008), and wound complications (4.2 vs. 1.2%, p=0.006), when compared to those without prior abdominal surgery. Previous major abdominal surgery was an independent risk factor for conversion to open surgery [adjusted odds ratio=2.740; 95% confidence interval (CI) 1.197-6.269]. Disease-free survival [adjusted hazard ratio (HR)=0.847; 95% CI 0.532-1.346] and overall survival (adjusted HR=0.846; 95% CI 0.432-1.657) were not observed to differ between the previous major abdominal surgery group and those without previous abdominal surgery. Laparoscopic colorectal surgery in patients with a history of abdominal surgery exhibited acceptable short- and long-term outcomes. Patients with a history of previous abdominal surgery had relatively higher rate of conversion to open surgery as well as higher incidences of prolonged postoperative ileus and wound complications compared to patients without such history.

Body composition analysis for discrimination of prolonged hospital stay in colorectal cancer surgery patients

We aimed to ascertain the implementation of body composition assessment, by means of fat-free mass index (FFMI), fat mass index (FMI) and presence of sarcopenic obesity, in colorectal cancer population, on the basis of hospital length of stay (LOS) determination and to benchmark their discriminatory performance with other nutrition status algorithms, such as body mass index (BMI) and Malnutrition Universal Screening Tool (MUST). Ninety adult patients with operable colorectal cancer were enrolled. Study parameters included demographic and anthropometric data registration, BMI and MUST calculation and body composition parameters measurement within 24-h post-admission. Hospital LOS constituted the outcome of interest, using 7days as cut-off point. Fifty-one patients (56.7%) were hospitalised for ≤7days. The presence of sarcopenic obesity affected adversely hospital LOS (OR, 9.236; 95% CI, 3.278-26.173, P=0.000). Low FFMI (OR, 7.457; 95% CI, 2.868-19.390, P=0.000), malnutrition according to MUST (OR, 2.632; 95% CI, 1.280-5.413, P=0.009) and high FMI (2.133; 95% CI, 1.111-4.094, P=0.023) were the most powerful discriminators of accelerated hospitalisation. Loss of lean body tissue, gain of adipose tissue and sarcopenic obesity confer noteworthy prognostic value being superior or equivalent to MUST in terms of hospital LOS determination in colorectal cancer resection setting. BMI presents inferior discrimination performance in this field.

Is previous abdominal surgery still a contraindication for laparoscopic surgery in colorectal cancer patients?

Is previous abdominal surgery still a contraindication for laparoscopic surgery in colorectal cancer patients?