Search results

1

Risk factors in reoperations in colorectal surgery

100%

Zawadzki M., Krzystek-Korpacka M., Rząca M., Czarnecki R., Obuszko Z., Sitarska M., Witkiewicz W.

Polish Journal of Surgery

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2019

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vol. 91(4)

13-18

EN

Background: Reoperations in colorectal surgery are usually a consequence of major surgical complications. Recently, the rate of reoperation has been proposed as a marker of surgical performance. Yet, the incidence of re-intervention varies significantly in literature, ranging from 5.2% to 13%. Therefore, in this study we investigated 30-day reoperation rates and made an attempt to identify risk factors of re-intervention following colorectal resection at our institution. Methods: This is a retrospective study of patients who had undergone colorectal resection at a single institution from 2013 to 2017. Univariate and multivariate analysis of predicting factors were performed. Results: Out of 464 patients included, 51 required reoperations (11%). The most common causes of reoperations were anastomotic leakage, postoperative bleeding, and wound dehiscence. In univariate analysis the age of the patient and location of the tumor were related to an increased rate of reoperation. In multivariate analysis patients older than 75 (OR = 2.1; 95%CI = 1.1–3.9) and tumors sited in the rectum (OR = 2.66; 95%CI = 1.4–5) were associated with an increased risk of re-intervention. Patients who required postoperative re-intervention stayed in hospital longer (14 vs. 6 days, P < 0.0001) and had higher mortality (9.8% vs. 1.2%, P = 0.002). Conclusions: Our study shows that reoperation rates that follow colorectal surgery are frequently undervalued. In our series, 11% of patients required an unplanned return to the operative room. Patient’s age and rectal tumors were the two independent factors that affect the rate of reoperation. Novel aspect: Data concerning reoperation rates in colorectal surgery is varying and most reports have shown the incidence of re-intervention to be as low as 5–7%. Our study demonstrates that reoperations after curative surgery for colorectal cancer are more frequent and may occur in over a tenth of total patients operated on.

2

Surgical treatment of extra-appendiceal colorectal neuroendocrine tumors.

100%

Maryański J., Cyran-Chlebicka A., Szczepankiewicz B., Cebulski W., Słodkowski M., Wroński M.

Polish Journal of Surgery

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2018

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vol. 90(3)

7-12

EN

Background: Extra-appendiceal colorectal neuroendocrine tumors are rare neoplasms with variable biological behavior. Materials and Methods: The study group consisted of 15 patients with an extra-appendiceal colorectal neuroendocrine tumor who underwent surgical resection (M/F=3:12, mean age=62.9 years). Lower-grade neuroendocrine tumors (NET G1-G2) and neuroendocrine carcinomas were recognized in 5 and 10 patients, respectively. Data were evaluated retrospectively with regard to clinical and pathologic characteristics and outcomes. Results: The median age of the patients with lower-grade NETs was significantly lower than that in patients with NECs (53 yrs vs. 68 yrs, p=0.03). NETs G1-G2 were significantly smaller than neuroendocrine carcinomas (4.0 cm vs. 6.4 cm, p=0.02). There were no differences between lower-grade NETs and NECs with regard to tumor location, local infiltration, rate of nodal involvement, and distant metastases. All the patients underwent open segmental resection of the colon or rectum. Complete resection was achieved in 3 of 5 patients from the lower-grade NET group, and in 5 of 10 patients in the NEC group (p=1.0). The overall survival was significantly better for lower-grade NETs tumors (p=0.005). The median survival was 4.8 months in the NEC group. The median survival in the lower-grade NET group was not achieved after a median follow-up of 69 months. Three-year overall survival was at a level of 100% for lower-grade NETs, and only 27% for NECs. Conclusion: Lower-grade neuroendocrine tumors seem to exhibit comparable potential for dissemination as neuroendocrine carcinomas, however, prognostic implications of metastases are distinct.

3

Evaluation of inflammatory markers as predictors of hospital stay and unplanned readmission after colorectal surgery

100%

Krpata D. M., Keller D. S., Samia H., Lawrence J., Obokhare I., Marderstein E., Brady K. M., Delaney C. P.

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vol. 85

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issue 4

198-203

EN

Hospital length of stay (LOS) and readmissions continue to be expensive and unexpected events following colorectal surgery (CRS) whether patients follow enhanced recovery pathways or traditional care. Predictors of these adverse events could facilitate identification and optimization of CRS patients. The aim of the study was to examine the impact of white blood cell count (WBC) and C-reactive protein (CRP) levels as predictors of delayed recovery or hospital readmission following CRS. Material and methods. Patients undergoing laparoscopic or open abdominal colorectal surgery by a single surgeon were managed using standardized enhanced recovery pathways. Those with postoperative day 2 CRP and white blood cell values were evaluated. Outcomes included 30-day hospital readmission rates and postoperative length of hospital stay. Results. CRP values were available for 193 patients (86 Male, mean age 58.6 years). Ninety-nine patients had surgery for colon cancer, 23 for Crohn’s disease, 19 for ulcerative colitis, 31 for diverticulitis and 18 for other reasons. Twenty patients (10.4%) were readmitted to the hospital within 30 days of surgery. POD2 CRP accurately predicted short length of hospital stay (p< 0.01). Average CRP was 6.3 in the LOS of < 3 days or less, and 11.7 in patients with LOS >4 days. The mean CRP of the readmission and non-readmission groups was 11.8 and 9.9, respectively (p=0.29). The average POD 2 WBC of the readmission and non-readmission groups was 10.6 and 9 respectively (p=0.01). Conclusion. A low POD2 CRP level was correlated with a shorter LOS, but it did not predict readmission. Conversely, POD2 WBC, and the difference in WBC from baseline were associated with readmission. These markers may be useful indicators to predict suitability of early discharge in an ERP. Further evaluation in prospective trials is warranted.

4

Checklist in colorectal surgery – proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery

100%

Banasiewicz T., Krokowicz Ł., Richter P., Dziki A., Krokowicz P., Lorenc Z., Szczepkowski M., Drews M., Wallner G.

Polish Journal of Surgery

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2017

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vol. 89(6)

44-49

EN

A checklist is a collection of information that helps reduce the risk of failure due to limitations in human memory and attention. In surgery, the first Surgical Safety Checklist (SSC), created under the supervision of WHO (World Health Organization), was established in 2007 and covers three stages related to the patient's stay in the operating theater and operation: 1. Prior to initiation (induction) of anesthesia; 2. before cutting the skin; 3. before the patient leaves the operating room Colorectal surgery is particularly at high risk for complications and relatively high mortality. Elimination or, more likely, reducing the risk of complications by standardizing perioperative procedures may be particularly important in this group. The introduction of "dedicated" colorectal checklist surgery seems to be justified. The checklist proposed by the authors in colorectal surgery is divided into four stages, in which conscientious completion of checklists is intended to reduce the potential risk of complications due to hospitalization and surgical treatment. The presented checklist is obviously not closed, as a new publications or recommendations appear, some points may be modified, new issues may be added to the checklist. At present, however, it is a tool considering the well-known and confirmed elements of intraoperative procedures, the compliance of which may significantly reduce the rate of adverse events or surgical complications.

5

Implementation of extended prolonged venous thromboembolism prophylaxis with rivaroxaban after major abdominal and pelvic surgery – overview of safety and early outcomes

100%

Tyselskyi V., Wong D., Tryliskyy Y., Poylin V., Kebkalo A.

Polish Journal of Surgery

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2020

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vol. 92(6)

22-27

EN

Purpose: Venous thromboembolism (VTE) after colorectal surgery is a well-documented complication, resulting in a general recommendation of extended post-discharge prophylaxis. Rivaroxaban, a factor Xa inhibitor, is a daily tablet approved for treatment of VTE and prophylaxis after orthopedic surgery. Aim: The purpose of this study is to evaluate the safety of rivaroxaban for extended prophylaxis after major abdominal and pelvic surgery. Methods: This is a retrospective review of patients undergoing major colorectal surgery at a regional hospital in Kiev, Ukraine. Patients received peri-operative VTE prophylaxis with subcutaneous heparin and then transitioned to rivaroxaban for a total of 30 days. Occurrences of major or minor bleeding, blood transfusion, and a need for re-intervention were noted. Phone surveys were administered on post-operative day 30 to assess compliance and satisfaction with the regimen. Results: A total of 51 patients were included in the study with an average age of 62.4 years. Seventy-one percent of the cases were abdominal, 29% were pelvic cases and 59% were done laparoscopically. There was one episode of major intra-abdominal bleeding requiring return to the operating room. There were 2 minor bleeding episodes which did not require intervention. There were no VTE events in the group. The phone survey response rate was 100%. All but one patient reported having completed the full course of rivaroxaban. Patients reported that oral prophylaxis was easy to adhere to and preferable compared to injections. Conclusion: Implementation of extended prophylaxis with rivaroxaban is easy, safe and does not increase rates of postoperative bleeding.

6

Colorectal surgery in elderly population

100%

Zawadzki M., Krzystek-Korpacka M., Rząca M., Czarnecki R., Obuszko Z., Witkiewicz W.

Polish Journal of Surgery

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2018

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vol. 90(4)

29-34

EN

Introduction: With the rising number of elderly patients and increasing incidence of colorectal cancer, management of geriatric patients has become the forefront of colorectal surgery. Objectives: This study aimed to investigate the short-term surgical outcomes that follow colorectal resection in elderly patients. Materials and methods: A total of 464 patients who underwent surgical resection for colorectal tumor between 2013 and 2017 were included. The patients were divided into a group of the elderly (≥75 years) and the young (<75 years). Clinicopathological data of the patients were reviewed retrospectively. Results: The elderly group constituted 30% of the study population. A greater number of patients in the elderly group underwent Hartmann’s procedure (p = 0.02) and right hemicolectomy (p = 0.029), and younger patients more often received low anterior resection (p = 0.027). The duration of the surgical procedure was shorter in the elderly group (p < 0.01) but they stayed in the hospital one day longer (p = 0.023). Postoperative complications and mortality tended to be higher in seniors (p = 0.088). The younger patients showed a tendency towards a higher rate of distant metastases (p = 0.053). Seniors received fewer preoperative chemoradiation in comparison to the young group (p = 0.014). Conclusion: Older persons constitute one-third of patients treated electively in colorectal departments. Colorectal surgery in geriatric patients is associated with a prolonged hospital stay and a higher potential for complications and mortality.

7

Physiotherapy Based on PNF Concept for Elderly People After Conventional Colon Surgery

88%

Czyżewski P., Szczepkowski M., Domaniecki J., Dąbek A.

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vol. 85

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issue 9

475-482

EN

Aging population, increases the number of major abdominal surgery (MAS) performed in the elderly. Main goal of physiotherapy after that surgery is prevention postoperative complications and reduction of functional limitation. The aim of the study was to asses functional status elderly people after MAS during early postoperative physiotherapy. Material and methods. In a prospective randomized study involved 34 patients scheduled for elective MAS, aged 65+. Patients were randomly assigned to receive PNF or conventional physiotherapy. The study included forced spirometry (FVC, FEV1, PEF) and functional tests (gait speed, up&go). Measurements were performed before surgery and the fourth day after surgery. Also analyzed age, sex, BMI and the level of postoperative independence (postoperative independence scale SAP). Kolmogorow- Smirnow test was used to check normal distribution, t-Student was used to check whether two sets of data differ significantly, and r-Pearsons for correlations testing. p values <0.05 were considered significant. Results. After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value. FVC%, FEV1%, PEF% values was decrease. In the PNF group was found significantly higher postoperative independence(SAP) and shorter length of stay in hospital compared to conventional physiotherapy group. Results of SAP and functional tests were significantly positive correlated. Conclusions. Major abdominal surgery decrees efficiency of walking and lung ventilation after 65 year old in early postoperative period. Some techniques of the PNF concept used in improving older patients after the MAS may favourably affect the postoperative increase independence and reduce the time of hospitalization.

8

Internal hernia following laparoscopic colorectal surgery: single center experience

88%

Svraka M., Wilhelmsen M., Bulut O.

Polish Journal of Surgery

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2017

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vol. 89(5)

19-22

EN

Although internal hernias are rare complications of laparoscopic colorectal surgery, they can lead to serious outcomes and are associated with a high mortality of up 20 %. Aim of the study: The aim of this study was to describe our experience regarding internal herniation following laparoscopic colorectal surgery. Materials and methods: From 2009 to 2015, more than 1,093 laparoscopic colorectal procedures were performed, and 6 patients developed internal herniation. Data were obtained from patients’ charts and reviewed retrospectively. Perioperative course and outcomes were analyzed. Results: All patients were previously operated due to colorectal cancer. Two patients presented with ischemia at laparotomy, and 2 had endoscopic examinations before surgery. One patient was diagnosed with cancer on screening colonoscopy. One patient died after laparotomy. Conclusion: Internal herniation that develops following laparoscopic colorectal surgery may be associated with a high mortality. More efforts should be made to identify risk factors of internal herniation, as this could indicate which patients would benefit from closure of mesenteric defects during laparoscopic colorectal surgery.

9

The use of the enhanced recovery after surgery (ERAS) protocol in patients undergoing laparoscopic surgery for colorectal cancer – a comparative analysis of patients aged above 80 and below 55

75%

Pędziwiatr M., Pisarska M., Wierdak M., Major P., Rubinkiewicz M., Kisielewski M., Matyja M., Lasek A., Budzyński A.

Polish Journal of Surgery

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2015

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vol. 87(11)

565-572

EN

Age is one of the principal risk factors for colorectal adenocarcinoma. To date, older patients were believed to achieve worse treatment results in comparison with younger patients due to reduced vital capacity. However, papers have emerged in recent years which confirm that the combination of laparoscopy and postoperative care based on the ERAS protocol improves treatment results and may be particularly beneficial also for elderly patients. The aim of the study was to compare the outcomes of laparoscopic surgery for colorectal cancer in combination with the ERAS protocol in patients aged above 80 and below 55. Material and methods. The analysis included patients aged above 80 and below 55 undergoing elective laparoscopic colorectal resection for cancer at the 2nd Department of General Surgery of the Jagiellonian University. They were divided into two groups according to their age: ≥80 years of age (group 1) and ≤55 years of age (group 2). Both groups were compared with regard to the outcome of surgery: length hospital stay, complications, hospital readmissions, degree of compliance with the ERAS protocol, and recovery parameters (tolerance of oral nutrition, mobilisation, need for opioids, restored gastrointestinal function). Results. Group 1 comprised 34 patients and group 2, 43 patients. No differences were found between both groups in terms of gender, BMI, tumour progression or surgical parameters. Older patients typically had higher ASA scores. No statistically significant differences were found with regard to the length hospital stay following surgery (5.4 vs 7 days, p=0.446481), the occurrence of complications (23.5% vs 37.2%, p=0.14579) or hospital readmissions (2.9% vs 2.4%). The degree of compliance with the ERAS protocol in group 1 and 2 was 85.2% and 83.0%, respectively (p=0.482558). Additionally, recovery parameters such as tolerance of oral nutrition (82.4% vs 72.1%, p=0.28628) and mobilisation (94.1% vs 83.7%, p=0.14510) within 24 hours of surgery did not differ among the groups. However, a smaller proportion of older patients required opioids in comparison with younger patients (26.5% vs 55.8%, p=0.00891). Conclusions. Similar levels of compliance with the ERAS protocol may be achieved among patients aged ≥80 and younger patients. When laparoscopy is combined with the ERAS protocol, age does not seem to be a significant factor that could account for worse utcomes. Therefore, older patients should not be excluded from perioperative care based on ERAS principles.

10

The Influence of Physical Activity on Physiotherapy Effects After Abdominal Surgery in Elderly People

63%

Czyżewski P., Domaniecki J., Dąbek A., Kopytiuk R.

Advances in Rehabilitation

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2013

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vol. 27

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issue 3

1-8

EN

Introduction: Elderly people are at the higher risk of colon cancer. Most of them request surgery. Main goal of physiotherapy after major abdominal surgery (MAS) is prevention postoperative complications and reduction of functional limitation. Physical activity level and functional status are close connected for 65+ patients. Daily activity independence, mental efficiency and well-being depend on physical activity level of elderly people. The aim of this study was to determine the correlations between physical activity level, functional status and lung function of elderly people in early postoperative physiotherapy period. Material and methods : Prospective randomized study involved 34 patients scheduled for elective MAS, aged 65+. Patients were randomly assigned to receive PNF or conventional physiotherapy. The study included forced spirometry (FVC, FEV1, PEF) and functional tests (gait speed, up&go). Measurements were performed before surgery and the fourth day after surgery. Also analyzed age, sex, BMI and the level of postoperative independence (postoperative independence scale SAP). Training intensity and capacity was the same in both groups. Kolmogorow-Smirnow test was used to check normal distribution, t-Student was used to check whether two sets of data differ significantly, and r- Pearsons for correlations testing. P values <0.05 were considered significant. Results: After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value. FVC%, FEV1%, PEF% values decreased. Level of physical activity had influence on results in evaluated tests of walking and lung ventilation. There was no significant changes after surgery to preoperative value for these measurements in high physical activity group. High active group had better results on SAP scale than low and middle activity group. Conclusions: MAS decrees efficiency of lung ventilation and walking after 65 year old in early postoperative period. High physical activity level patients scheduled for major abdominal surgery had positive impact on postoperative lung ventilation, ability and independence in walking in hospital period.

11

Evaluation Of Life Quality In Colorectal Cancer Patients

63%

Kayserilioğlu G., Aygin D.

Innowacje w Pielęgniarstwie i Naukach o Zdrowiu

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2023

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vol. 8

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issue 2

37-59

PL

Wstęp. Okres diagnostyczny choroby nowotworowej, proces leczenia oraz powikłania spowodowane zabiegami negatywnie wpływają na jakość życia pacjenta i jego bliskich, którzy wspierają jego opiekę. Pojęcie jakości życia zyskało w ostatnich latach na znaczeniu ze względu na wydłużenie średniej długości życia oraz wzrost świadomości społecznej. Cel.Rak jelita grubego wpływa negatywnie na jakość życia jednostek. W pracy zbadano jakość życia chorych na raka jelita grubego oraz czynniki wpływające na jakość ich życia. Materiał i metoda. Próbę badawczą stanowiło 110 pacjentów, którzy zgłosili się do Poradni/Serwisu Chirurgii Ogólnej i Oddziału Chemioterapii Szpitala Państwowego i Szpitala Szkolno-Badawczego w okresie od 01.05.2014 do 01.11.2015. Dane ankietowe zebrano za pomocą kwestionariusza społeczno-demograficznego EORTC QLQ-C30 i EORTC QLQ-CR38 (Europejska Organizacja Badań i Leczenia Raka) oraz Skali Depresji Becka. Do oceny danych wykorzystano liczbę, procent, średni rozkład, analizę wariancji, test U Manna-Whitneya i test Kruskala-Wallisa z oprogramowaniem SPSS v.20.0. Wyniki. Średni wiek pacjentów z rozpoznaniem raka jelita grubego wynosił 61,9 ± 10,92 lat. Ustalono, że 61,8% pacjentów stanowili mężczyźni, 87,3% było w związkach małżeńskich, a 20,9% miało w rodzinie historię choroby nowotworowej. Stwierdzono, że kobiety częściej niż mężczyźni odczuwały problemy ze stomią, a postrzeganie obrazu własnego ciała przez pacjentki było gorsze niż mężczyzn. Stwierdzono, że pacjenci mają wysoką funkcję emocjonalną i wysoki poziom bólu; i mają niskie wyniki zaparć w podskali objawów. Wyniki pacjentów związane z problemami ze stomią były wysokie, a oceny przyjemności seksualnej niskie. Stwierdzono, że wiek, liczba dzieci, stan cywilny i wykształcenie pacjentów mają wpływ na jakość życia. Wnioski. W rezultacie wraz z postępem wieku chorych na raka jelita grubego i wzrostem liczby dzieci pogarszał się stan funkcjonalny i zwiększała się częstość występowania objawów. Stwierdzono, że płeć nie wpływa na jakość życia ani depresję.

EN

Introduction. The diagnostic period of cancer, the treatment process and the complications caused by the treatments negatively affect the quality of life of the patients and his relatives who support his care. The concept of quality of life has gained more importance in recent years due to reasons such as prolonged life expectancy and increased public awareness. Aim. Colorectal cancer affects the life quality of individuals negatively. In this study, life quality of colorectal cancer patients and the factors affecting their quality of life were examined. Materials and method. The sample of the study consisted of 110 patients who applied to the General Surgery Clinic/Service and Chemotherapy Unit in State Hospital and Training and Research Hospital between 01.05.2014 and 01.11.2015. Survey data were collected using the socio-demographic questionnaire, EORTC QLQ-C30 and EORTC QLQ-CR38 (European Organization for Research and Treatment of Cancer Core Questionnaire) and Beck Depression Scale. Number, percentage, mean distribution, variance analysis, Mann-Whitney U test and Kruskal-Wallis test were used with SPSS v.20.0 software in evaluating the data. Results. The mean age of the patients diagnosed with colorectal cancer was obtained 61.9 ± 10.92 years. It was determined that 61.8% of the patients were male, 87.3% were married, and 20.9% had cancer history in their family. It has been determined that, women suffered more from stoma-related problems than men and the perception of the body image of female patients were worser than men. Patients were found to have a high emotional function and high pain level; and have low constipation scores in the symptom subscale. Patients' scores related to stoma problems were high and sexual enjoyment scores were low. The age, number of children, marital status and educational status of the patients were found to have an influence on the quality of life. Conclusion. As a result, as the age of colorectal cancer patients progressed and as the number of children increased, the functional status was worse and the incidence of symptoms was higher. It was determined that gender did not affect the quality of life or depression.

Refine search results

Risk factors in reoperations in colorectal surgery

Surgical treatment of extra-appendiceal colorectal neuroendocrine tumors.

Evaluation of inflammatory markers as predictors of hospital stay and unplanned readmission after colorectal surgery

Checklist in colorectal surgery – proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery

Implementation of extended prolonged venous thromboembolism prophylaxis with rivaroxaban after major abdominal and pelvic surgery – overview of safety and early outcomes

Colorectal surgery in elderly population

Physiotherapy Based on PNF Concept for Elderly People After Conventional Colon Surgery

Internal hernia following laparoscopic colorectal surgery: single center experience

The use of the enhanced recovery after surgery (ERAS) protocol in patients undergoing laparoscopic surgery for colorectal cancer – a comparative analysis of patients aged above 80 and below 55

The Influence of Physical Activity on Physiotherapy Effects After Abdominal Surgery in Elderly People

Evaluation Of Life Quality In Colorectal Cancer Patients