Outcome after emergency surgery for cancer of the large intestine

Runkel, N.; Schlag, Peter M.; Schwarz, V.; Herfarth, Ch.

doi:10.1002/bjs.1800780216

Cited by 185 publications

(99 citation statements)

References 28 publications

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“…Previous studies have found that obstruction and perforation tend to occur in the older age groups. 24,25 Our study was also in agreement with this observation.…”

Section: Discussionsupporting

confidence: 92%

Role of histopathological examination in nontraumatic perforation of colon

Singla

Mahajan²,

Agarwal³

et al. 2012

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Aim: Nontraumatic perforation of colon is an uncommon cause of peritonitis requiring early surgical intervention. This study was carried out to determine the prevalence patterns of the different etiologies of nontraumatic perforation of colon. Methods and results: A total of 35 patients with segments of colon or perforation margins removed for perforation were included. Most of the perforations occurred in the caecum, of which two were seen at the ileocaecal junction. The commonest cause was infection (amoebiasis :13 cases and tuberculosis : 5 cases) followed by ulcers of non specific ulcers (12 cases). There were three cases of adenocarcinoma causing secondary perforation and one case of idiopathic intestinal gangrene and volvulus each. Conclusion: In tropics, non traumatic perforations of colon most often involves caecal and ileocaecal segment and the most common etiology is amoebiasis.

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“…Previous studies have found that obstruction and perforation tend to occur in the older age groups. 24,25 Our study was also in agreement with this observation.…”

Section: Discussionsupporting

confidence: 92%

Role of histopathological examination in nontraumatic perforation of colon

Singla

Mahajan²,

Agarwal³

et al. 2012

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“…Emergency colon surgery itself had a higher mortality rate than non-emergency colon surgery [2,[12][13][14]. The present study is of potential interest because sepsis is a very common problem in elderly patients who undergo emergency colorectal surgery.…”

Section: Discussionmentioning

confidence: 76%

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

Zou

Cai

et al. 2012

Indian J Surg

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Serum procalcitonin (PCT) levels may have predictive value in the prognosis of postoperative sepsis in elderly patients who have undergone colorectal surgery for colorectal cancer in intensive care units (ICUs). A prospective study involving 90 critically ill patients who underwent colorectal surgery for colorectal cancer in ICUs was performed. Twenty-eight patients were diagnosed with sepsis, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria, and these patients were included in the sepsis group. Sixtytwo patients, who were without evidence of sepsis, were enrolled in the control group. We measured the serum PCT concentrations preoperatively (immediately before induction of anesthesia), upon arrival in the ICU (ICU day 0), on the morning of the first postoperative day (postoperative day 1), and on the morning of the third postoperative day (postoperative day 3). The C-reactive protein (CRP) index, acute physiology and chronic health evaluation II (APACHE II) score, mechanical duration of ventilation, mortality rate, incidence of multiple organ failure, and usage of continuous renal replacement therapy were evaluated. The area under the curve for the receiver operating characteristic curve (AUC-ROCC) was measured to explore the association between the serum PCT and the prognosis. In the sepsis group, 12/28 patients died (mortality rate 43 %). In the control group, 6/ 62 patients died (mortality rate 9.7 %). On the first postoperative day, the serum PCT level was dramatically higher in the sepsis group than in the control group (2.71±1.13 vs. 1.37± 0.57, P≤0.05). The PCT level on the first postoperative day was distinctly higher than that measured upon arrival in the ICU (2.71±1.13 vs. 1.31±0.58, P≤0.05). In the two groups, the CRP concentrations were both markedly higher on the first postoperative day than upon arrival in the ICU (138.89±45.12 vs. 70.43±23.54 in the sepsis group, and 133.13±44.91 vs. 69.65±24.98 in the control group, P≤0.05). Linear regression analysis was performed. The results suggest that the PCT and APACHE-II scores were not significantly associated. On the first and third postoperative days, the PCT levels were associated with increased odds of sepsis (AUC-ROCC, 95 % confidence interval 0.817-0.973, P 00.000, and 0.755-0.944, P00.000, respectively). The outcomes of patients in the sepsis group were worse than those in the control group. PCT levels appear to be early markers of postoperative sepsis in elderly patients undergoing colorectal surgery for colorectal cancer during the ICU course. These findings could allow for early identification of postoperative septic complications and be used for prognostic evaluation of these patients.

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“…[1][2][3]6 Emergency sur- gery for colorectal obstruction carries a higher morbidity than elective colon surgery and mortality of 10% to 28%. [1][2][3][4][5][6] This difference in outcome is related to the poor medical condition of the patients as well as to the unprepared bowel resulting in increased infectious complications. Effective measures that will allow for the delay of surgery until patients can be medically optimized and undergo mechanical preparation of the colon could result in improved outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The need for emergent surgery in a patient with an unprepared colon leads to significant morbidity and mortality. [1][2][3][4][5][6] In patients with advanced malignant disease or with prohibitive operative risk, surgical intervention for colorectal obstruction appears even less appealing. The need for a less morbid treatment modality has led to the use of self-expandable metallic stents (SEMS) to relieve colorectal obstruction.…”

Section: Introductionmentioning

confidence: 99%