Outcomes of Hand-Assisted Laparoscopic Surgery for Colorectal Disease in an Emergency Setting

Kim, Yongbog; Cheng, Yuanyu; Lee, Donghyoun; Kim, Hyung Ook; Kim, Hungdai; Chun, Ho-Kyung; Jung, Keechul

doi:10.7602/jmis.2017.20.4.143

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…Recent evidence demonstrated laparoscopic resections for complicated diverticular disease (Hinchey I‐III) to be feasible with encouraging outcome . For obstructing colorectal cancer, laparoscopic approach was linked to shorter length of stay and reduced mortality . Despite an expected lower overall ERAS compliance in the urgent setting (32% of patients with >70% ERAS compliance), ERAS has been adopted as routine care pathway and associated with benefits in the present institution and by others …”

Section: Discussionmentioning

confidence: 99%

“…Unfavourable patient‐ and disease‐related conditions in patients needing emergency colectomy go along with increased postoperative complication rates . Nevertheless, recent data showed primary resection as valid option for complicated diverticulitis or obstructive colon cancer, with further benefits through laparoscopic approach in selected cases . Tailored enhanced recovery protocols turned out to be feasible and beneficial even for urgent indications .…”

Section: Introductionmentioning

confidence: 99%

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Fluid management for critical patients undergoing urgent colectomy

Grass¹,

Pache²,

Butti³

et al. 2019

Evaluation Clinical Practice

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Rationale:The present study aimed to define thresholds for perioperative fluids and weight gain after urgent colectomies. Method: Consecutive urgent colonic resections within an enhanced recovery pathway (2011-2017) were included. Primary outcomes were postoperative complications, stratified as overall (I-V) and major (IIIb-V) according to Clavien scale. Fluid-management-related thresholds were identified through receiver operating characteristics (ROC) analysis. Outcomes were compared for patients above vs below threshold, and multivariable logistic regression was performed to identify risk factors for overall complications. Results: Overall, complications were observed in 133 out of 224 patients (59%), severe complications in 43 patients (19%). For overall complications, area under ROC (AUROC) was 0.71, identifying a critical cut-off of 3 L of total IV fluid administration at the day of surgery (negative predictive value [NPV]: 90%). Further, a critical cut-off for postoperative weight gain of 2.3 kg at postoperative day (POD) 2 wasidentified (AUROC 0.7, NPV 92%). Multivariable analysis identified fluid administration of >3 L (OR 5.33; 95% CI, 2.36-12.02) and weight gain of >2.3 kg at POD 2 (OR 2.5; 95% CI, 1.13-5.53) as independent predictors for overall complications.Median length of stay was 7 (5-10) days in patients receiving <3 L at POD 0 and 13 (9-19) days in patients receiving >3 L (P < .001).Conclusions: Fluid administration of 3 L at the day of surgery and weight gain of 2.3 kg at POD 2 may represent critical thresholds for adverse outcomes after urgent colectomy. The suggested thresholds need to be confirmed through independent validation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fluid management for critical patients undergoing urgent colectomy

Grass¹,

Pache²,

Butti³

et al. 2019

Evaluation Clinical Practice

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“…Several studies found similar disease specific survival for elderly and young colorectal cancer patients [28][29][30][31] , but difference in overall survival; this means that the increase of mortality in oncogeriatric patients is due to competing causes of death and not to CRC. Consequently decreased survival in the elderly is mainly due to differences in early mortality [28,[32][33][34][35][36] .…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 94%

“…Consequently decreased survival in the elderly is mainly due to differences in early mortality [28,[32][33][34][35][36] . Some authors showed that time between admission and surgery doesn't increase morbidity and mortality rates [29] ; others, demonstrated that delays in performing emergency surgery in elderly patients leads to higher complication rates [3,30] .…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

Emergency Surgery for Colorectal Cancer in Patients Aged Over 90 Years: Review of the Recent Literature

Belinda

Catena

2016

Journal of Tumor

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derly people; approximately 60% of patients are aged >70 years at time of diagnosis and 43% of cases are aged >75 years in the western countries [1][2][3] . These proportions will likely continue to increase in the near future, because of the increasing percentage of people living past ninety years, a phenomenon associated with the aging world population.In Italy, according to the Italian National Institute of Statistics (ISTAT) data, the population aged 85 and older will increase from 2.8% in 2011 to 7.8% in 2050, reaching an average life expectancy of 85.3 years for males and 90.5 years for females.This highly significant demographic change in modern society has an important impact on health care, especially in cancer care, as cancer in people aged over 90, poses an ethical dilemma for surgeons and oncologists: non operative management or medical and/or surgical treatment? To treat is an over treatment?In clinical practice, the management of this group of patients is frequently suboptimal, consequently an increasing number of nonagenarian CRC patients are admitted in emergency departments, requiring surgical treatment.Generally, emergency abdominal procedures are associated with increased morbidity and mortality rates, particularly for frail elderly patients. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with comorbidities.Another important issue to consider is the high costs of the postoperative care for this group of patients which frequently demand rehabilitation and longer recovery, even after minor surgery.We decided to review the recent literature to discuss current strategies in the management of oncogeriatric patients aged over ninety in emergency. MATERIALS AND METHODSWe performed a search by Cochrane Library, MEDLINE, and EMBASE for potentially relevant scientific articles on emergency surgery for colorectal cancer in nonagenarian patients. We considered in our review all the scientific papers published in the last ten years up to June 2015. We included in this study randomized controlled ABSTRACTThe aging of the world population is leading to an increase in the number of patients aged over ninety needing for a surgical treatment in emergency setting. Colorectal cancer in people over 90 years of age represents an ethical dilemma for surgeons and oncologists, above all when the neoplastic disease is advanced and complicated by obstruction and/or perforation. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with frailty, polipharmacy and comorbidities.We decided to review the recent literature to discuss the latest strate-gies in the management of colorectal cancer in emergency situations, for patients aged over ninety.

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“…7 HALS is the one of the approach methods of minimally invasive surgeries; it also has better short-term benefit when compared to conventional open surgery. But there few studies which compare the HALS and open surgery.…”

Section: Editorialmentioning

confidence: 99%