Non-surgical complications after laparoscopic and open surgery for colorectal cancer − A systematic review of randomised controlled trials

Schiphorst, A. H. W.; Verweij, Norbert M.; Pronk, Apollo; Rinkes, I.H.M. Borel; Hamaker, Marije E.

doi:10.1016/j.ejso.2015.04.007

Cited by 53 publications

(34 citation statements)

References 44 publications

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“…ROC curve analysis revealed the thresholds to be most significant for respiratory complications, which occurred in 4·0 per cent of the study population, similar to findings in other studies of laparoscopic surgery. These thresholds were found to be independent predictors of further adverse events.…”

Section: Discussionsupporting

confidence: 83%

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

et al. 2019

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Background Perioperative fluid overload is an important modifiable risk factor for adverse outcomes after colorectal surgery. This study aimed to define critical thresholds for perioperative fluid management and postoperative weight gain for patients undergoing elective laparoscopic colorectal surgery. Methods This was an analysis of consecutive elective laparoscopic colorectal resections at Lausanne University Hospital from May 2011 to May 2017. Main outcomes were overall, major (Clavien–Dindo grade IIIb or above) and respiratory complications, and postoperative ileus. Thresholds regarding perioperative fluid management and postoperative weight gain were identified through receiver operating characteristic (ROC) analysis and clinical judgement. Independent risk factors for all four outcomes were assessed by multinominal logistic regression. Results Overall and major complications occurred in 210 (36·2 per cent) and 46 (7·9 per cent) of 580 patients respectively. Twenty‐three patients (4·0 per cent) had respiratory complications and 98 (16·9 per cent) had postoperative ileus. Median length of hospital stay was 5 (i.q.r. 3–9) days. Based on respiratory complications, thresholds for perioperative intravenous fluid administration (postoperative day (POD) 0) were set pragmatically at 3000 ml for colonic (calculated threshold 3120 ml (area under ROC curve (AUROC) 0·63)) and 4000 ml for rectal (AUROC 0·79) procedures. Postoperative weight gain of 2·5 kg at POD 2 was predictive of respiratory complications. Multivariable analysis retained perioperative intravenous fluid administration over the above thresholds as an independent risk factor for overall (odds ratio (OR) 2·25, 95 per cent c.i. 1·23 to 4·11), major (OR 2·49, 1·17 to 5·31) and respiratory (OR 4·71, 1·42 to 15·58) complications. Weight gain above 2·5 kg at POD 2 was identified as a risk factor for respiratory complications (OR 3·58, 1·10 to 11·70) and ileus (OR 1·82, 1·02 to 3·52). Conclusion Perioperative intravenous fluid and weight thresholds were associated with postoperative adverse outcomes. These thresholds need independent validation.

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Section: Discussionsupporting

confidence: 83%

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

et al. 2019

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“…Patients with a higher ACCI score had a higher risk of prolonged POI. Epidemiologic, quality evaluation, and health services studies aimed at improving the health outcomes of patients with CRC undergoing surgical resection are gaining increasingly more attention [32, 33]. The ACCI promises to be a highly useful tool in such research.…”

Section: Discussionmentioning

confidence: 99%

Age-adjusted charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection

Tian

et al. 2017

Oncotarget

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Comorbidities had considerable effects on the development of postoperative ileus (POI). The primary aim of the present study was to determine the influence of the age-adjusted Charlson comorbidity index (ACCI) score on the risk of prolonged POI in patients with colorectal cancer who underwent surgical resection. Using the electronic Hospitalization Summary Reports, we identified 11,397 patients with colorectal cancer who underwent surgical resection from 2013 through 2015. Logistic regression models were applied to evaluate the effect of the ACCI score on the risk of prolonged POI. The ACCI score had a positive graded association with the risk of prolonged POI in both colon and rectal cancer (P for trend < 0.05). Among patients with rectal cancer, after adjusting for potential confounders, those with an ACCI score of 4–5 had a 108% higher risk of prolonged POI than those with an ACCI score of 0–1 (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.09–3.98), and those with an ACCI score of ≥ 6 had a 130% higher risk (OR, 2.30; 95% CI, 1.08–4.89). Among patients with colon cancer, those with an ACCI score of ≥ 6 had a 47% greater risk of prolonged POI than those with an ACCI score of 0–1 (OR, 1.47; 95% CI, 1.07–2.02). These findings suggested that a higher ACCI score was an independent predictor of the development of prolonged POI.

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“…Mortality appears to be as low as 1% in elective colorectal surgeries but has been reported up to 5.8% (Schiphorst et al 2015, Tevis & Kennedy 2013. It has been reported to be as high as 15% for emergency colorectal surgeries (McGillicuddy et al 2009).…”

Section: Mortalitymentioning

confidence: 98%

“…Medical complications can include pulmonary, cardiovascular and other systems. Wolters et al 1996, Atalay et al 2011, Schiphorst et al 2015. Other reported complications include urinary tract infections, renal failure/insufficiency, sepsis, gastroenteritis and delirium have also been documented as complications (Wolters et al 1996, McGillicuddy et al 2009, Artinyan et al 2008, Longo et al 2000, Bosma et al 2016.…”

Section: Types Of Complicationsmentioning

confidence: 99%

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

Flahive¹,

Driscoll²,

Broderick³

2018

Physiotherapists

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Objective: The primary aim of the study is to evaluate the physical function performance differences between those who develop complications and those who do not and determine their impact on recovery. Background: Complication rates in abdominal (colorectal, hernia repair & cholecystectomies) surgery are variable and appear to be lower in minimally invasive, less complex surgery. Complications are associated with significant costs in terms of morbidity, finance, psychological and impact on recovery. Factors that have been identified as associated with complications include age, BMI, surgical approach, co-morbidities, American Society of Anaesthesiologists (ASA) status, physical function frailty and level of dependency. It is also clear that these factors individually are unlikely predictors but highlight the need for multifactorial assessment. Surgical procedures in their essence cause significant physiological stress which can often mimic similar physiological effects of exercise. Cardiopulmonary exercise testing (CPET) can be useful in predicting complications, however is generally unavailable and not always suitable. No one measure has been identified to predict complications in an abdominal surgery population, hence the need to evaluate physical function performance as a whole and analyse differences that may emerge between those who develop complications and those who do not. Methods: Participants were recruited (n = 49) via the pre-operative assessment unit in the University Hospital Limerick. Pre-operative assessment included the following: demographics data, six-minute walk distance, VO2Peak, spirometry, peak cough flow, self-reported activity using the International Physical Activity Questionnaire (IPAQ), ASA score, surgical Physical function performance and recovery of patients undergoing abdominal surgery in relation to complications-A prospective real world study-4-grade, Malnutrition Universal Scoring Tool (MUST) score, albumin and creatinine levels. Post-surgery data included surgery type, length, surgical approach, initial 24-hour pain relief, length of stay and complications. At 30 and 60 days, participants were contact via telephone and the telephone IPAQ repeated, questioned regarding their self-assessed physical recovery and post hospital discharge complications. Results: Surgery types fell into the following 4 categories: colorectal (n = 21), colorectal reversals (n = 7), hernia repairs (n = 10) and cholecystectomies (n = 5). The complications rate was 41.9% (n=18) pre-discharge, 30.2% (n=13) at 30 day's post-surgery and 21% (n = 9) at 60 day's post-surgery. Obesity (P=0.005*), longer operating time (P=0.05*), >2 co-morbidities (P = 0.033*), low activity levels (P=0.020*), low VO2Peak (P=0.017*) and lower 6-minute walk distance (P=0019*) were statistically different between complications and non-complications groups with worse scores seen in the complications group. Length of stay was significantly increased in the complications groups at a median of 8.5 nights versus 2 nights in the non-compl...

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Non-surgical complications after laparoscopic and open surgery for colorectal cancer − A systematic review of randomised controlled trials

Cited by 53 publications

References 44 publications

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

Age-adjusted charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection

Physical function performance and recovery of patients undergoing abdominal surgery in relation to post-operative complications–A prospective real world study

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