Complicated Colorectal Cancer Research Articles

The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project

The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project

Quality of Life in Patients Undergoing Emergency Surgery for Complex Colorectal Cancer: Protocol and Piloting of the Surgical Utilization and Recovery Patterns for Advanced Stage Colorectal Cancer Study.

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway.

Endoscopic stenting of a tumor of the rectosigmoid junction

Annotation. Obturational obstruction of the large intestine of tumor genesis belongs to acute surgical pathology and the issue of operative tactics in this case is extremely important in emergency surgery. The current trend in the treatment of complicated colorectal cancer is to carry out radical surgical interventions with the formation of primary anastomoses and compliance with basic oncological principles. However, carrying out such interventions under adverse conditions, including neglected oncological processes, the presence of severe concomitant pathologies, late hospitalization, instability and uncompensated indicators of the patient's homeostasis, leads to a high risk of developing various postoperative complications and postoperative mortality. Therefore, the use of endoscopic methods of restoring the patency of the large intestine with the help of stents is becoming widely used. Endoscopic colonic stenting is one of the modern, promising methods of treatment for patients with intestinal obstruction. It is characterized by minimal invasiveness, and a significantly lower frequency of post-surgery complications and mortality. According to the recommendations of the European Society of Gastrointestinal Endoscopy, colonic stenting is used for patients with clinical symptoms and radiological signs of tumor obstruction of the colon without signs of perforation; installation of a stent for compensation of homeostasis systems, for comprehensive preoperative preparation (if necessary, with the use of chemotherapy or X-ray therapy). The article presents the results of our own clinical observation of an endoscopic colonic stenting case as a method of symptomatic treatment of colonic obstruction in a patient with colorectal cancer and severe concomitant diseases. We analyzed the peculiarities of using colonic stents and determined the importance of mastering this method for proctologists and oncoproctologists.

Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study.

Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.

Multimodality imaging in assessment of intestinal complications pre-stomal reversal

BackgroundSeveral imaging modalities are available to assess complications post intestinal stoma creation. The aim of this study was the radiological assessment of intestinal complications pre-stomal closure using routine fluoroscopic water-soluble contrast enema (WSCE), combined CT-WSCE, and MRI-enema with rectal gel administration. Additionally, we aimed to investigate the potential alterations in the surgical management plan based on imaging findings.ResultsThis prospective cross-sectional study recruited 130 patients with stomas referred for the assessment of stoma integrity. Thirty-six patients with stoma-related intestinal complications were included. Patients with complications were subdivided into 3 groups. Group A 15 patients with intestinal stomas referred for WSCE pre-stomal closure and complementary CT-WSCE evaluation was performed. Comparison between the detection of the complications by WSCE alone and combined CT-WSCE among group A was statistically significant (p = 0.008) yet the alteration of the surgical plan based on both modalities was not statistically significant (p = 0.063). Group B 11 patients with poor general conditions were referred directly for combined CT-WSCE assessment, complications diagnosed in this group: 6 (54.5%) intestinal obstruction, 2 (18.2%) pericolic collections, 2 (18.2%) abnormal fistula and 1 (9.1%) anastomotic leak. Group C 10 patients with intestinal stomas with malignant or inflammatory conditions referred directly for MRI-enema assessment, showed complications as follows: 3 (30%) colon/rectal tumoral recurrence, 2 (20%) strictures, 2 (20%) pericolic collections and 3 (30%) abnormal intestinal fistulous communications. Comparison between complicated colorectal cancer patients (20 patients) versus other complicated patients secondary to other surgical indications (16 patients) enrolled in the study from the 3 different groups was not statistically significant (p = 0.125).ConclusionsCombined CT and WSCE is superior in the detection of intestinal fistulas, peri-colic collections, tumor recurrence, and para-stomal hernias than WSCE alone and might lead to a change of management. MRI after rectal gel administration can serve as reliable substitute in some patients for the detection of intestinal complications namely fistulas and tumor recurrence.

Clinicopathological Analysis of Complicated Colorectal Cancer: A Five-Year Retrospective Study from a Single Surgery Unit.

Patients with primary colorectal cancer can present with obstructions, tumor bleeding, or perforations, which represent acute complications. This paper aimed to analyze and compare the clinical and pathological profiles of two patient groups: one with colorectal cancer and a related complication and another without any specific complication. We performed a five-year retrospective study on colorectal cancer patients admitted to a surgery unit and comparatively explored the main clinical and pathological features of the tumors belonging to the two groups. A total of 250 patients with colorectal cancer were included in the analysis. Of these, 117 (46.8%) had presented a type of complication. The comparative analysis that examined several clinical and pathological parameters showed a statistically significant difference for unfavorable prognosis factors in the group with complications. This was evident for features such as vascular and perineural invasion, lymph node involvement, pathological primary tumor stage, and TNM stage. Colorectal cancers with a related complication belonged to a group of tumors with a more aggressive histopathologic profile and more advanced stages. Furthermore, the comparable incidence of cases in the two groups of patients warrants further efforts to be made in terms of early detection and prognosis prediction of colorectal cancer.

Management of complicated colorectal cancer in Benghazi hospitals

Introduction: Colorectal cancer (CRC) is the third most frequent malignant disease in men and second most frequent in women. The treatment of emergency cases of CRC presented with complication is different than elective controlled cases. Aim: of this study is to find the best way to treat a patient admitted as an emergency case of complicated colorectal cancer. Methods: The medical data of 102 patients was retrospectively evaluated for those who were admitted as emergency cases with acute or subacute intestinal obstruction, perforation or bleeding colorectal cancer to Al-Jalla Hospital, Benghazi Libya. Three different emergency treatment methods were received as follow: · Tumor resection, · Damage control procedure with elective or semi elective resection, and · No radical treatment. Primary endpoints were 6 months mortality and morbidity. Secondary endpoints were length of hospital stay, number of lymph nodes, rate of radical R0 resections, and the number of patients who had received chemo-radiotherapy. Results: 55 patients had immediate resection and colostomy. 33 patients were inoperable because the cancer was too advanced or they were too ill to tolerate an operation. 10 had damage control followed by elective resection. There was no statistically proven significant difference between immediate resections and 2-stage treatment. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection. Conclusion: This study couldn't determine which treatment is better, even with using staging resection.

Laparoscopic Hartmann Procedure-A Surgery That Still Saves Lives.

A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump and end colostomy, has as its indications: advanced or complicated rectosigmoid neoplasm, moderate biological condition of the patient, peritoneal sepsis, intestinal occlusion and fragile colonic wall, especially in the context of inflammatory changes. The Hartmann procedure can save lives even at the cost of a stoma reversal failure. The cases operated with the Hartmann procedure by an open approach or laparoscopic approach in our clinic, between 1 January 2016 and 31 December 2020, were admitted in this study and their medical records were reviewed, also making a comparison between the two types of approach. Univariate statistical comparisons but also a multivariate analysis was performed. We performed 985 operations for intestinal and colonic occlusion (7.15% of the total operations in the clinic), 531 (54%) were non-tumor occlusions and 454 (46%) were occlusive tumors (88 Hartmann operations). Of these, 7.3% were laparoscopically performed (7 laparoscopic Hartmann operations and 23 diagnostic laparoscopies). A total of 11 cases (18%) also had colonic perforation. We compared laparoscopic Hartmann with open Hartmann and observed the benefits of laparoscopy for postoperative morbidity and mortality. The presence of pulmonary and cardiac morbidities is associated with the occurrence of general postoperative morbidities, while peritonitis is statistically significantly associated with the occurrence of local complications that are absent after the laparoscopic approach. The Hartmann procedure is still nowadays an operation widely used in emergency situations. Laparoscopy may become standard for the Hartmann procedure and reversal of the Hartmann procedure, but the percentage of laparoscopy remains low due to advanced or complicated colorectal cancer, poor general condition both at the first and second intervention, and the difficulties of reversal of the Hartmann procedure.

The Systemic Inflammation Marker NLR as a Prognostic Factor in Complicated Colorectal Cancer

Many recent scores based on the inflammatory response, such as Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Lymphocyte Monocyte Ratio (LMR) have been demonstrated to have a prognostic value in cancer patients. The ratio between neutrophils and lymphocytes is a very useful tool, most studies admitting its role as a prognostic marker in cancer. We made a retrospective study on 391 patients hospitalized and operated in emergency for complicated colorectal cancer in the Surgery II clinic of the "St. Ap. Andrei" from Galati, Romania, between 2008-2017. We demonstrated that the increased preoperative value of NLR was a negative prognostic factor for long-term survival in patients with complicated colorectal cancer (HR = 7.581, 95% CI = (6.358,9.039) (p = 0.000000)). The cut-off point is > 2.61, with sensitivity of 73.61 and specificity of 100.00. The mean survival time in patients with NLR < = 2.61 was 39,676, 95% CI = (37,189, 42,163) and in those with NLR > 2.61 it was 12,504, 95% CI = (11,747, 13,261), the difference between the survival time of patients with values ​​above the cutoff and below the cutoff being statistically significant (p = 0.000000, Log-Rank).

Efficacy and Feasibility of Complete Mesocolic Excision with Central Vascular Ligation in Complicated Colorectal Cancer.

Complete mesocolic excision (CME) with central vascular ligation (CVL) involves sharp dissection through the embryological planes. However, it may be associated with high mortalities and morbidities especially in colorectal emergencies. This study aimed to investigate the outcomes of CME with CVL in complicated colorectal cancers (CRCs). This was a retrospective study of emergency CRC resection in a tertiary center between March 2016 and November 2018. A total of 46 patients, with a mean age of 51years, underwent an emergency colectomy for cancer (males, 26 [56.5%]; females, 20 [43.5%]). CME with CVL was performed for all patients. The mean operative time and blood loss were 188min and 397mL, respectively. Only five (10.8%) patients presented with burst abdomen, whereas only three (6.5%) presented with anastomotic leakage. The mean length of vascular tie was 8.7cm, and the mean number of harvested lymph nodes (LNs) was 21.2. Emergency CME with CVL is a safe and feasible technique when performed by a colorectal surgeon and will result in obtaining a superior specimen with a large number of LNs.

Overall survival in elderly patients with acute complications of colorectal cancer

AIM: to assess risk factors affecting the five-year overall survival in patients ≥ 70 years old who underwent emergency surgery for complicated colorectal cancer.PATIENTS AND METHODS: a cohort retrospective study included 268 patients with complicated colorectal cancer for the period from January 10, 2010 to March 03, 2020, operated on in hospitals in Smolensk. Inclusion criteria: 1) patients underwent emergency surgery for decompensated bowel obstruction or tumor perforation with peritonitis; 2) histological type of tumor: adenocarcinoma, signet ring cell carcinoma, undifferentiated cancer; 3) age ≥ 70 years. Non-inclusion criteria: 1) subcompensated bowel obstruction, paratumoral inflammation, intestinal bleeding; 2) non-epithelial malignant tumors; 3) age < 70 years.RESULTS: the significant differences were revealed in overall survival rates depending on the type of surgery. In complicated colon cancer, overall survival after one-stage surgeries was 15.35%, after tumor removal at the first stage — 21.51%, and after surgeries with tumor removal at the second stage — 46.59% (p < 0.00001). For complicated rectal cancer: 1.03%, 1.6%, and 16.49%, respectively (p = 0.00402). The main factors that had an unsatisfactory effect on overall survival: surgery type — one-stage and multi-stage with tumor removal at the first stage (risk ratio (RR) 1.34; 95% coincidence interval (CI) 1.17–1.56; p < 0.0001); tumor perforation (OR 1.46, 95% CI: 1.36–1.55; p < 0.0001); disease stage (OR 1.61, 95% CI: 1.45–1.69; p < 0.0001), tumor site (OR 1.24, 95% CI: 1.29–1.72; p = 0.004); tumor histological type — poorly differentiated adenocarcinoma (OR 1.5, 95% CI: 1.24–1.62; p < 0.0001), the number of lymph nodes examined < 12 (OR 0.69, 95% CI: 0.59–0.63; p < 0.0001), presence of positive resection margins (R1 and/or CRM+) (OR 1.29, 95% CI: 1.14–1.47; p < 0.0001); severe comorbidity (OR 1.95, 95% CI: 1.62–1.98; p = 0.003), no adjuvant treatment (OR 0.57, 95% CI: 0.49–0.63; p < 0.0001).CONCLUSION: staged procedures with a minimal volume in an emergency and the second — main stage, performed in a specialized hospital, are the most appropriate in patients ≥ 70 years old.

Overall survival in elderly patients with acute complications of colorectal cancer

AIM: to assess risk factors affecting the five-year overall survival in patients ≥ 70 years old who underwent emergency surgery for complicated colorectal cancer.PATIENTS AND METHODS: a cohort retrospective study included 268 patients with complicated colorectal cancer for the period from January 10, 2010 to March 03, 2020, operated on in hospitals in Smolensk. Inclusion criteria: 1) patients underwent emergency surgery for decompensated bowel obstruction or tumor perforation with peritonitis; 2) histological type of tumor: adenocarcinoma, signet ring cell carcinoma, undifferentiated cancer; 3) age ≥ 70 years. Non-inclusion criteria: 1) subcompensated bowel obstruction, paratumoral inflammation, intestinal bleeding; 2) non-epithelial malignant tumors; 3) age < 70 years.RESULTS: the significant differences were revealed in overall survival rates depending on the type of surgery. In complicated colon cancer, overall survival after one-stage surgeries was 15.35%, after tumor removal at the first stage — 21.51%, and after surgeries with tumor removal at the second stage — 46.59% (p < 0.00001). For complicated rectal cancer: 1.03%, 1.6%, and 16.49%, respectively (p = 0.00402). The main factors that had an unsatisfactory effect on overall survival: surgery type — one-stage and multi-stage with tumor removal at the first stage (risk ratio (RR) 1.34; 95% coincidence interval (CI) 1.17–1.56; p < 0.0001); tumor perforation (OR 1.46, 95% CI: 1.36–1.55; p < 0.0001); disease stage (OR 1.61, 95% CI: 1.45–1.69; p < 0.0001), tumor site (OR 1.24, 95% CI: 1.29–1.72; p = 0.004); tumor histological type — poorly differentiated adenocarcinoma (OR 1.5, 95% CI: 1.24–1.62; p < 0.0001), the number of lymph nodes examined < 12 (OR 0.69, 95% CI: 0.59–0.63; p < 0.0001), presence of positive resection margins (R1 and/or CRM+) (OR 1.29, 95% CI: 1.14–1.47; p < 0.0001); severe comorbidity (OR 1.95, 95% CI: 1.62–1.98; p = 0.003), no adjuvant treatment (OR 0.57, 95% CI: 0.49–0.63; p < 0.0001).CONCLUSION: staged procedures with a minimal volume in an emergency and the second — main stage, performed in a specialized hospital, are the most appropriate in patients ≥ 70 years old.

Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

Visceral-to-Subcutaneous Fat Ratio Is a Potential Predictor of Postoperative Complications in Colorectal Cancer.

BackgroundColorectal cancer (CRC) is one of the most common malignant tumors. Surgery is the primary treatment for CRC. Recent studies have shown that visceral-to-subcutaneous fat ratio (VSR) may be a potential indicator of risk. The aim of the present study was to determine whether VSR is a suitable predictor of the impact of postoperative complications in CRC.Material/MethodsClinical data from 129 patients were analyzed retrospectively. All patients underwent laparoscopic surgery for CRC. Preoperative imaging was used to quantify VSR. The primary outcome was 30-day postoperative complications. Multivariate logistic regression was used to determine the association between obesity indexes and postoperative complications.ResultsThere were 129 patients who underwent primary resections of colorectal cancer. At 30 days after surgery, postoperative complications had occurred in 33 (25.6%) patients. VSR was significantly associated with postoperative complications in multivariate analysis (P=0.032, OR 6.103, 95% CI 1.173–31.748). In ROC analysis, VSR was a potential predictor of complications (AUC 0.650). A cutoff value of VSR ≥0.707 was associated with 60% sensitivity and 29% specificity for postoperative complications. Patients with VSR ≥0.707 had 41.7% risk of morbidity, whereas those with <0.707 had 16.0% risk (P=0.001).ConclusionsOur study shows that VSR is superior to VFA for prediction of the risk of complications following CRC laparoscopic surgery. We have also identified the optimal cutoff values for the use of VSR for this purpose. Measurement of VSR and identifying patients with increased risk of postoperative complications facilitate making perioperative decisions.

The Complete Blood Count Modified Results in Patients with Complicated Colorectal Cancer

Abstract Introduction Among the factors on which the long-term survival of patients with colorectal cancer depends, the biological status at admission is essential and it is well reflected by a simple, routine analysis: The complete blood count (CBC). The link between the values of the hemoleukogram parameters and the diagnosis of colorectal cancers, but also between the changes in the hemoleukogram and the prognosis of patients with colorectal cancer is well documented in the literature. The aim of this study is to show the link between CBC changes at admission and the survival of patients with complicated colorectal cancer. Patients and methods We conducted a retrospective study that included 431 patients admitted and operated in emergency for complicated colorectal cancer, in the Surgery II Clinic of the Clinical Emergency County Hospital "St. Ap. Andrei" from Galati between 2008-2017. We made statistical correlations between the 4 types of emergency operations (external derivations, Hartmann, internal derivations and resections with anastomosis) and CBC changes, as well as a survival analysis depending on the presence of these changes. Results The presence of anemia at admission is statistically significant correlated with the practice of emergency colostomies and the presence of leukocytosis is correlated with Hartmann operations. In our study, only the anemia was a negative prognostic factor for the long-term survival of patients with complicated colorectal cancer. Conclusions The complete blood count is a routine, simple, cost-effective laboratory test that can be a very useful tool in assessing the prognosis of patients with complicated colorectal cancer.

Morbidity, mortality, and risk factors of emergency colorectal surgery among older patients in the Acute Care Surgery service: A retrospective study

BackgroundAcute Care Surgery (ACS) is a rapid response system in emergency surgical conditions. The patients who over 60 year-old have numerous factors associated with high mortality and morbidity in emergency colorectal surgery. We aimed to identify potentially preventable risk factors, to improve patients’ outcomes. MethodsA retrospective review of patients age over 60 year-old undergoing emergency colorectal surgery in the ACS service from August 1, 2017 through November 30, 2019. ResultsNinety-two patients were analyzed, average age 72.41 years. The most common diagnosis was complicated colorectal cancer (76, 83.52%) with locations on the right (37, 41.51%), left (35,39.33%), and rectum (17, 19.10%). Clinical presentations were obstruction without perforation (61, 67.03%), perforation (25, 27.17%), and ischemia (2, 2.17%). Overall mortality was 6.52%. Cause of death included septic shock (3, 50%); respiratory failure (3, 50%); and pulmonary embolism (1, 16.67%). Morbidity from surgical and medical complications were 41.30% and 26.08%, respectively. For all causes, operations included resection with primary anastomosis (62, 71.26%); Hartmann's operation (11, 12.64%); and loop colostomy (12, 13.79%). Average operative time was 159.86 min. In emergency colorectal surgery, pre-existing heart disease, clinical perforation, and ventilator dependency increased risk of death 7.6-, 16.5-, and 0.08-fold, respectively. ConclusionClinical perforation leads to sepsis and septic shock in older patients, this may be modifiable to improve mortality by developing an early, rapid, protocol-driven surgical sepsis fast-track process. Ventilator dependency is potentially modifiable with postoperative advanced surgical critical care. The non-modifiable risk factor of co-morbid heart disease might be improved by postoperative advanced critical care for close monitoring.

Emergency surgery for complicated colorectal cancer – What we choose: a retrospective cohort study

Introduction: Despite the progress that has been made regarding the diagnosis, a worrying percentage of patients are still admitted in an emergency, with complicated colorectal tumors, which often require interventions without a curative visa. The study aims to analyze the factors involved in choosing the type of surgical treatment. Patients and methods: We included in the study a group of 431 patients admitted and operated in an emergency for complicated colorectal cancer in the Surgery II Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galați, between 2008-2017. We retrospectively analyzed the patients’ data and we made statistical correlations between the type of emergency surgery and epidemiological, clinical, paraclinical, and intraoperative factors. Results: Colostomy was mainly practiced in older patients.

A Complicated Colorectal Cancer Recurrence

Summary The case report demonstrates painstaking, one step at a time multitherapy for the third most common cancer and the third cause of cancer death in western countries – colorectal cancer. Multitherapeutic approach at specialized centers for the treatment of colorectal cancer is the cornerstone for reaching favorable treatment results and prognosis.

Time and Season Incidence of Complicated Colorectal Cancer

Colorectal cancer complications are seldom analyzed for occurrence through day and night, working days and weekends, as well as throughout seasons. We hypothesized that information and analysis of high/low complicated colon cancer incidence in the above mentioned terms can improve our preparedness and manage better the resources for superior outcomes. Therefore we performed a retrospective study/2010 – 2018/ of 165 patients with complicated colorectal cancer operated on emergently or urgently in the Second Clinic of General and Thoracic Surgery, University Hospital St George, Plovdiv, Medical University Plovdiv, Bulgaria.

The Importance of Systemic Inflammation Markers in the Survival of Patients with Complicated Colorectal Cancer, Operated in Emergency.

Introduction: The inflammatory response plays a critical role in carcinogenesis. There are recent scores based on the systemic inflammatory response, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), which have been shown to have prognostic value in cancer patients. These scores allow the identification of patients who will have poor response to treatment and poor survival. The aim of this study is to evaluate the prognostic role of NLR, PLR, LMR and PNI in terms of long-term survival in patients with colorectal cancer, operated in emergency. Material and Methods: We included 391 patients admitted and operated for complicated colorectal cancer in the Surgery II clinic of the Clinical Emergency County Hospital Sf. Ap. Andrei - from Galati, between 2008-2017. We analyzed the paraclinical factors of systemic inflammation NLR, PLR, MRL and PNI. As prognostic factors, survival curves were analyzed. Results: The high values of NLR and PLR increased the risk of death (HR = 7.581, 95% CI = (6.358,9.039), p value = 0.000000, respectively HR = 1.043, 95% CI = (1.039, 1.047), p value = 0.000000), and the increased values of LMR and PNI led to the decrease of this risk (HR = 0.069, 95% CI = (0.054.0.090), p value = 0.000000, respectively HR = 0.758, 95 % CI = (0.730.0.788), p value = 0.000000). In the multivariate regression analysis, the increase of PLR resulted in an increase in the risk of death (HR = 1.024, 95% CI = (1.019.1.029), p value = 0.000000), and for the LMR and PNI, a reduction of the risk of death (HR = 0.353, 95% CI = (0.248.0.504), p value = 0.000000, respectively HR = 0.852, 95% CI = (0.822.0.883), p value = 0.000000). Conclusions: The univariate analysis showed that NLR and PLR are risk factors, and LMR and PNI are protective factors in terms of survival. The multivariate analysis revealed that PLR is an independent risk factor, and LMR and PNI were independent protection factors.