Elective and emergency surgery for colorectal cancer in a district general hospital: impact of surgical training on patient survival.
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Abstract:
A total of 640 patients were studied retrospectively after surgery for colorectal cancer over a 5-year period at a district general hospital. The complications, perioperative survival figures, and 5-year survival figures were recorded with particular reference to the grade of surgeon carrying out the original operation. The number and type of complications were similar for consultants and for surgeons-in-training with the exception of operative injury to the ureters and postoperative anastomotic strictures, which were more common in cases operated on by consultants. Perioperative mortality rates were similar after elective and emergency operations, but emergency surgery was associated with a significant increase in mortality when compared with elective surgery if the operation was undertaken by a trainee. Although the 5-year survival rate rose when a consultant surgeon carried out the original operation, the difference was not significant.Keywords:
Elective surgery
Emergency Surgery
General hospital
Colorectal Surgery
Colonic cancer
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A total of 640 patients were studied retrospectively after surgery for colorectal cancer over a 5-year period at a district general hospital. The complications, perioperative survival figures, and 5-year survival figures were recorded with particular reference to the grade of surgeon carrying out the original operation. The number and type of complications were similar for consultants and for surgeons-in-training with the exception of operative injury to the ureters and postoperative anastomotic strictures, which were more common in cases operated on by consultants. Perioperative mortality rates were similar after elective and emergency operations, but emergency surgery was associated with a significant increase in mortality when compared with elective surgery if the operation was undertaken by a trainee. Although the 5-year survival rate rose when a consultant surgeon carried out the original operation, the difference was not significant.
Elective surgery
Emergency Surgery
General hospital
Colorectal Surgery
Colonic cancer
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The perioperative risk was prospectively analyzed in 511 patients with colorectal cancer, out of which 5% had an emergency procedure. The morbidity rate was 23.6% without an association with tumour stage or localization. The incidence of nonsurgical complications rose with increasing age because of a rising number of concomitant illnesses (< 50: 5.7%, > 80: 28.1%). The morbidity was associated with an increasing blood loss during the operation (< 500 ml: 10.6%, > 2000 ml: 30.4%), but not with the type of treatment. The overall operative mortality rate was 2.3% with the same rate of surgical complications and complications of preexisting conditions. Morbidity and mortality following emergency procedure were 56%, respectively 20%, expressing mainly septical complications of colorectal cancer.
Concomitant
Emergency Surgery
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The purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean (s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P less than 0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P less than 0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.
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Perioperative hypothermia occurs frequently and can have serious health-related and financial consequences. Despite multiple warming methods available, perioperative hypothermia remains prevalent. To be effective, preventative measures must be timely and target patients most at risk. The aim of this retrospective review was to document the incidence and patterns of hypothermia in patients undergoing major colorectal surgery.Hospital records were used to obtain demographic and clinical information on 255 patients undergoing major colorectal surgery over one year. Temperatures were recorded from five perioperative time-points and correlated with potential contributing factors.Most patients (74%) experienced mild hypothermia, which was most common intraoperatively. Elective patients experienced the greatest drop in temperature between admission and commencement of surgery while emergency patients experienced a similar drop intraoperatively. The most significant determinant of intraoperative hypothermia was core temperature at the start of surgery (P < 0.01). Factors increasing hypothermia at the start of surgery were an elective presentation, an arrival temperature below 36.5°C (P < 0.01) and an age greater than 70 years (P < 0.05).Mild hypothermia in patients undergoing major colorectal surgery is common, despite preventative measures. Core temperatures prior to commencement of the operation should be optimized with both active and passive warming measures, particularly for older patients and those arriving with lower core temperatures. Elective patients should also have their temperatures monitored as closely, if not more closely, than emergency patients. Preventing early declining trends in core temperature may positively influence later perioperative temperatures and improve outcomes.
Colorectal Surgery
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The purpose of this research was to assess the characteristics of octogenarian patients with colorectal cancer and compare specific outcomes due to different types of surgical procedures used to treat the disease.A total of 346 octogenarian patients undergoing surgery for colorectal cancer between April 2000 and April 2010 were retrospectively assessed according to elective (n = 261) or emergent (n = 85) admission group. The two groups were compared for clinical variables, surgical procedures, morbidity and mortality, ICU admission, length of hospital stay and overall survival.The two groups had similar comorbidities. The emergent group had a more advanced Dukes' stage, higher American Society of Anesthesiologists grading, lower anastomosis rate (40.2 vs 80.1%), higher stoma rate (30.6 vs 9.6%), more complications (71.8 vs 43.3%), nine days longer length of hospital stay and higher (82.4% vs 36.4%) ICU admission rate. Overall mortality was 9.5%, with a higher mortality rate in the emergent group (30.6%) than the elective group (3.1%).Octogenarians who undergo elective colorectal cancer surgery have better results than those requiring emergent surgery, but both are quite acceptable and we recommend surgical intervention should not be delayed.
Elective surgery
Surgical oncology
Colorectal Surgery
Stoma (medicine)
Emergency Surgery
Grading (engineering)
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Review of 475 cases of diverticular disease of the colon emphasized needs to stratify patients into clinical categories. Of 223 cases of diverticulosis coli, had significant colonic complaints which received no attention. Of 198 emergency admissions for acute diverticulitis, only 16 required emergency surgery. Resection in the face of serious peritonitis is not advisable. Twenty-seven elective resections gave excellent results. Three subtotal colectomies were successfully done for major bleeding. Final focus was on determination of therapy groups: medical, surgery advisable, and surgery inevitable.
Diverticular disease
Colorectal Surgery
Surgical oncology
Diverticulosis
Diverticulitis
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Citations (23)
Emergency surgery for obstructing colorectal cancer is associated with high mortality and morbidity rates.The purpose of this study was to assess outcomes of emergency surgery for obstructing colorectal cancer in a single hospital, where care was primarily provided by colorectal surgeons.This was a retrospective cohort study.The study was conducted at the Toyonaka Municipal Hospital.The study included 208 consecutive patients who underwent emergency surgery for obstructing colorectal cancer between 1998 and 2013.Surgical outcomes, including mortality and morbidity, were evaluated.The obstructing cancers involved the right colon, left colon, and rectum in 78, 97, and 33 of the included patients. Many patients had poor performance indicators, such as age ≥75 years (42%), ASA score of III or more (38%), stage IV colorectal cancer (39%), obstructive colitis (12%), and perforation or penetration (9.6%). Colorectal surgeons performed the operations in all but 5 of the patients. Primary resection and anastomosis were accomplished in 96%, 70%, and 27% of cases involving the right colon, left colon, and rectum. Intraoperative colonic irrigation (n = 32), manual colonic decompression (n = 11), and subtotal or total colorectal resection (n = 34) were performed before left-sided anastomoses. Anastomotic leak was reported in only 2 patients. The in-hospital mortality and morbidity rates were 1.3% and 34.0%.This study was a retrospective analysis of data from a single hospital.Surgical outcome analysis for obstructing colorectal cancers managed by specialized colorectal surgeons demonstrates low mortality and morbidity rates. Therefore, we concluded that our management of this condition is safe and feasible.
Colorectal Surgery
Perforation
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Colorectal Surgery
Multidisciplinary team
Colonic cancer
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