Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

Eriksen, Jens; Munk-Madsen, Pia; Kehlet, Henrik; Gögenur, Ismail

doi:10.1111/aas.13238

Cited by 17 publications

(37 citation statements)

References 20 publications

(30 reference statements)

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“…Orthostatic hypotension and orthostatic intolerance are common findings in the early postoperative period after laparoscopic colorectal surgery and contribute to dizziness and difficulty with mobilization . Dizziness occurred in 19% of patients without a stoma and 17% of patients with a stoma on POD 0, and was a reason for delayed discharge.…”

Section: Discussionmentioning

confidence: 99%

Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?

et al. 2019

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Aim Enhanced recovery after surgery programmes in elective colorectal surgery have been developed and implemented widely, but a subgroup of patients may still require longer hospital stays than expected. The aim of this study was to identify and describe factors compromising early postoperative recovery by asking ‘why is the patient still in hospital today?’ after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery programme. Method Patients undergoing elective laparoscopic colorectal cancer resection were evaluated postoperatively with predefined potential reasons for still being in hospital. The primary outcome was ‘reason for still being in hospital’ on postoperative day 0–4 and secondarily length of stay with a focus on differences between patients with and without a stoma. Results Ninety‐six patients having colorectal cancer surgery were included. The median length of stay for the whole group was 3 days (range 1–14). The four dominant causes for patients without a stoma to be in hospital were lack of gastrointestinal function, lack of early mobilization, lack of normal micturition and nausea. Patients with a stoma stayed in hospital due to stoma training, lack of gastrointestinal function, lack of free micturition and a miscellaneous ‘others’ group. Conclusion Delayed gastrointestinal function, insufficient mobilization, poor urinary function and stoma care training have been characterized as dominant compromising factors for postoperative recovery. Together with a focus on frailty, future studies should focus on improving early mobilization, prevention and treatment of postoperative urinary retention and improved stoma care training, in order to minimize delay in postoperative recovery and discharge.

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Section: Discussionmentioning

confidence: 99%

Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?

et al. 2019

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“…The institution is a tertiary colorectal cancer surgical unit performing more than 300 minimally invasive colorectal procedures annually and with a fully implemented ERAS protocol 28 . The perioperative care programme has been described in detail previously 29 . All patients received information regarding the procedure, admission and recovery from doctors, nurses, physiotherapists and dieticians 4-10 days before admission.…”

Section: Perioperative Coursementioning

confidence: 99%

Alterations in blood microbiota after colonic cancer surgery

et al. 2020

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Background: Mechanisms contributing to the perioperative stress response remain poorly understood. This study investigated changes in the amount of bacterial DNA in blood and the diversity of blood microbiota in the perioperative period in patients undergoing minimally invasive surgery for colonic cancer in an enhanced recovery after surgery setting. Methods: DNA encoding the bacterial 16S ribosomal RNA gene (16S rDNA) in whole blood obtained the day before surgery, and on postoperative day (POD) 1 and POD 10-14 was amplified and quantified by PCR before sequencing for taxonomic assignment. Richness, evenness and similarity measures were calculated to compare microbiota between days. Differences in relative abundance were analysed using the linear discriminant analysis effect size (LEfSe) algorithm. Results: Thirty patients were included between January and July 2016. The concentration of bacterial 16S rDNA in blood increased between the day before surgery and POD 1 (P = 0.025). Bacterial richness was lower on POD 10-14 than on the day before surgery and POD 1 (both P < 0⋅001). LEfSe analysis comparing the day before surgery and POD 10-14 identified changes in the abundance of several bacteria, including Fusobacterium nucleatum, which was relatively enriched on POD 10-14. Conclusion: These findings suggest that the blood of patients with colonic cancer harbours bacterial 16S rDNA, which increases in concentration after surgery.

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“…During the perioperative period, patients followed the standard of care for colon cancer in a setting of Enhanced Recovery After Surgery (ERAS), which has been described in detail for the department elsewhere [30]. There were no restrictions on pain management, and all patients were encouraged to take their regular medication after surgery.…”

Section: Settingmentioning

confidence: 99%

CDX2 expression and perioperative patient serum affects the adhesion properties of cultured colon cancer cells

et al. 2020

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Background: Colon cancer is one of the most commonly diagnosed types of cancer with surgical resection of the tumor being the primary choice of treatment. However, the surgical stress response induced during treatment may be related to a higher risk of recurrence. The aim of this study was to examine the effect of surgery on adhesion of cultured colon cancer cells with or without expression of the tumour suppressor CDX2. Method: We enrolled 30 patients undergoing elective, curatively intended laparoscopic surgery for colon cancer in this study. Blood samples were drawn 1 day prior to surgery and 24 h after surgery. The samples of pre-and postoperative serum was applied to wild type colon cancer LS174T cells and CDX2 inducible LS174T cells and adhesion was measured with Real-Time Cell-Analysis iCELLigence using electrical impedance as a readout to monitor changes in the cellular adhesion. Results: Adhesion abilities of wild type LS174T cells seeded in postoperative serum was significantly increased compared to cells seeded in preoperative serum. When seeding the CDX2 inducible LS174T cells without CDX2 expression in pre-and postoperative serum, no significant difference in adhesion was found. However, when inducing CDX2 expression in these cells, the adhesion abilities in pre-and postoperative serum resembled those of the LS174T wild type cell line. Conclusions: We found that the adhesion of colon cancer cells was significantly increased in postoperative versus preoperative serum, and that CDX2 expression affected the adhesive ability of cancer cells. The results of this study may help to elucidate the pro-metastatic mechanisms in the perioperative phase and the role of CDX2 in colon cancer metastasis.

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Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

Abstract: Postoperative orthostatic intolerance is a common problem during the first 24 hour following laparoscopic colorectal resection and may be followed by delayed recovery.

Cited by 17 publications

References 20 publications

Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?

Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?

Alterations in blood microbiota after colonic cancer surgery

CDX2 expression and perioperative patient serum affects the adhesion properties of cultured colon cancer cells

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