Risk factors for morbidity and mortality after colectomy for colon cancer

Longo, Walter E.; Virgo, Katherine S.; Johnson, Frank E.; Oprian, Charles; Vernava, Anthony M.; Wade, Terence P.; Phelan, Maureen; Henderson, William G.; Daley, Jennifer; Khuri, Shukri F.

doi:10.1007/bf02237249

Cited by 368 publications

(306 citation statements)

References 18 publications

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“…14,[31][32][33] Simultaneously, surgery is often performed regardless of age and comorbidity if only to avoid the consequences of tumor obstruction. 8 Estimating the risk of (postoperative) adverse outcomes is important in establishing informed patient consent and shared decision-making 34,35 on the extent of intended surgery and appliance of adjuvant therapy. However, the development of personalized care programs is bothered by limited knowledge about the relation of comorbidity and cancer biology and what (combination of) chronic diseases are prone for complications and death.…”

Section: Discussionmentioning

confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

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Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p 5 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine.Comorbidity composes a great challenge when treating patients with colorectal cancer (CRC). [1][2][3][4] In the Netherlands, CRC represents the second most frequent cancer in terms of incidence with more than 12,000 newly diagnosed patients annually and a lifetime risk of more than 5%. 5 As more than half of patients with CRC is aged older than 70 years, the diagnosis of CRC is often made amidst the presence of other chronic medical conditions. Treatment of patients with severe comorbidity is challenging because of polypharmacy and decreased compensating mechanisms, especially in older patients who also have normal age-related physiological changes. 6 The presence of a single or combination of chronic illnesses can affect both treatment effectiveness and tolerance, and is associated with worse short-and long-term outcomes after CRC surgery. [1][2][3][4][7][8][9][10][11] The prevalence of comorbidity is influenced by personal and environmental factors. Age, gender and socio-economic status (SES) have been described as interacting with the burden of specific comorbid ailments and influencing outcomes after CRC treatment. [12][13][14] Further, ageing, improved life expectancy and lifestyle habits in western countries will lead to a higher prevalence of (multiple) concomitant diseases among patients with CRC. 15,16 Objectifying increases in the burden of comorbi...

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Section: Discussionmentioning

confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

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“…Albumin has a long halflife of 20 d, so that metabolic effects on its concentration reflect prolonged malnourishment, as in cancer patients. Hypoalbuminemia is widely accepted to be a good indicator for malnutrition in many national cancer studies [7,11,17] . It is remarkable that tumor size, but not the stage, is relevant to hypoalbuminemia.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

Lohsiriwat¹,

Lohsiriwat²,

Boonnuch³

et al. 2008

WJG

112

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AIM:To determine the relationship between preoperative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS:The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS:The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m 2 ; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION:Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

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“…By contrast, it has long been recognized that low circulating albumin concentrations prior to surgery are associated with a poor outcome in patients with colorectal cancer (15)(16)(17). For example, heys et al (16) showed that low concentrations of circulating albumin before surgery and the magnitude of the decrease were associated with poor overall survival.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer

Toiyama

Miki

Inoue

et al. 2010

Experimental and Therapeutic Medicine

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Abstract. recent studies have revealed the Glasgow prognostic score (GpS) to aid in the prediction of postoperative outcome in colorectal cancer patients. however, whether GpS predicts poor prognosis in curative colorectal cancer patients has yet to be ascertained. Furthermore, there is no information on the association between GpS and adjuvant chemotherapy in stage ii or iii colorectal cancer patients. a total of 219 patients with stage ii and iii colorectal cancer were included in this trial. The modified GPS (mGPS) defined in this study was calculated on the basis of admission data as follows: patients with an elevated level of both c-reactive protein (0.5 mg/dl) and hypoalbuminemia (alb <3.5 mg/dl) were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. the association between the mGpS and clinicopathological findings and survival was retrospectively assessed. The mGPS was significantly higher in patients with an advanced age, serosal invasion, advanced stage cancer and pre-operative high cEa levels. Kaplan-meier analysis revealed that a higher GpS predicted a higher risk of postoperative mortality in stage ii and/or iii colorectal cancer patients. multivariate analyses revealed that the mGpS was the most sensitive predictor of postoperative mortality in stage ii/iii or stage ii, respectively. the prognosis of stage ii patients with a higher mGpS was as favorable as that of patients with a lower mGpS when adjuvant chemotherapy was undertaken. pre-operative mGpS is considered to be a useful predictor of postoperative mortality in patients with stage ii and/or iii colorectal cancer, independently of the cEa test or tnm system. postoperative adjuvant chemotherapy may be recommended for stage ii colorectal cancer patients with a high mGpS.

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Risk factors for morbidity and mortality after colectomy for colon cancer

Cited by 368 publications

References 18 publications

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer

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