Surgery for colorectal cancer in elderly patients.
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Abstract:
In 545 consecutive patients undergoing elective or emergency surgery for colorectal cancer (370 colon and 175 rectum), mortality and morbidity were analysed in different age groups with special reference to patients over 80 years old. In that group, 33% had an emergency operation, compared with 18% below that age. Postoperative mortality after elective surgery ranged from 3 to 11% in the different age groups, but was not significantly related to age. In contrast, postoperative in-hospital mortality after emergency surgery was high (38%) among those older than 80 years, compared with 6% below 75 years and 24% between 76 and 80 years. Postoperative morbidity, i.e. infections and cardiovascular disease, increased with age, as did the length of hospital stay. Five-year survival, independent of age, was poorer after emergency surgery than after elective surgery. It is concluded that elective colorectal resection for cancer in elderly patients is a safe procedure.Keywords:
Elective surgery
Emergency Surgery
Colorectal Surgery
Cancer surgery
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McClave, Stephen A. M.D.; Martindale, Robert G. M.D., Ph.D.; Maxwell, John P. M.D. Author Information
Colorectal Surgery
Surgical oncology
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Contraindication
Elective surgery
Cancer surgery
Colorectal Surgery
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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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In 545 consecutive patients undergoing elective or emergency surgery for colorectal cancer (370 colon and 175 rectum), mortality and morbidity were analysed in different age groups with special reference to patients over 80 years old. In that group, 33% had an emergency operation, compared with 18% below that age. Postoperative mortality after elective surgery ranged from 3 to 11% in the different age groups, but was not significantly related to age. In contrast, postoperative in-hospital mortality after emergency surgery was high (38%) among those older than 80 years, compared with 6% below 75 years and 24% between 76 and 80 years. Postoperative morbidity, i.e. infections and cardiovascular disease, increased with age, as did the length of hospital stay. Five-year survival, independent of age, was poorer after emergency surgery than after elective surgery. It is concluded that elective colorectal resection for cancer in elderly patients is a safe procedure.
Elective surgery
Emergency Surgery
Colorectal Surgery
Cancer surgery
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Purpose. Incidental appendectomies are frequently done during primary colorectal surgery. The benefits and possible adverse side effects of an incidental appendectomy lack evidence; thus, the procedure is controversial. We reviewed the 25-year experience of one specific surgeon in a single center by analyzing the benefits and possible complications, especially adhesion ileus, of incidental appendectomy. Methods. Medical records from 1987 to 2011 were retrospectively analyzed. Emergency operations and right-side colectomies were excluded. Results. We enrolled 701 patients of elective colorectal surgeries (mean age: 63.3 ± 12.2 years old); 106 patients had undergone an incidental appendectomy. There were no significant differences in gender, age, or diagnosis between patients with or without elective appendectomies. There were no significant increase of ileus or decrease it. Conclusion. Incidental appendectomy is a safe procedure without additional risks. It will not increase postoperative ileus, but neither will it decrease the already low incidence of appendicitis after colorectal surgery; therefore, incidental appendectomy did not prove beneficial.
Single Center
Colorectal Surgery
Ileus
Medical record
Emergency Surgery
Elective surgery
Postoperative Ileus
Colon resection
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The surgical management of acute complicated diverticulitis has evolved to avoid emergency surgery in favor of elective resection. The optimal manner to accomplish this goal remains debatable.The purpose of this study was to examine the efficacy of nonoperative management of acute diverticulitis with abscess or perforation.A retrospective review was performed of an institutional review board-approved database of patients admitted with a diagnosis of acute complicated diverticulitis from 1995 to 2008. Patient demographics, disease manifestation, management, and outcomes were collected.This study was conducted at a tertiary care hospital/referral center.Patients were included who presented with complicated diverticulitis defined as having an associated abscess or free air diagnosed by CT scan.Primary end points were the success of nonoperative management and need for surgery during the initial admission.One hundred thirty-six patients were identified with perforated diverticulitis: 19 had localized free air, 45 had abscess <4 cm or distant free air measuring <2 cm, 66 had abscess >4 cm or distant free air >2 cm, and 6 had distant free air with free fluid. Thirty-eight patients (28%) required percutaneous abscess drains and 37 (27%) required parenteral nutrition. Only 5 patients (3.7%) required urgent surgery at the time of admission, and 7 (5%) required urgent surgery for failed nonoperative management. Thus, the overall success rate of nonoperative management was 91%. One hundred twenty-four of 131 (95%) patients were treated with nonoperative management successfully. Twenty-five of 27 (92.5%) patients with free air remote from the perforation site were successfully treated nonoperatively.Nonoperative management of acute complicated diverticulitis is highly effective. For patients with free air remote from the site of perforation, nonoperative management is able to convert an emergent situation into an elective one in 93% of cases. The decision to attempt nonoperative therapy must be made based on the patient's physiologic state and associated comorbidities.
Diverticulitis
Perforation
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1From the University of Minnesota, Minneapolis, Minnesota Abridgment of original article read at the joint meeting of the American Proctologic Society and the Section of Proctology of the Royal Society of Medicine, Philadelphia, Pennsylvania, May 9 to 14, 1964. Assistant Professor, Surgery. Supported in part by the Andrew Dewing Memorial Fund.
Colorectal Surgery
Section (typography)
Surgical oncology
Cancer surgery
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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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Abstract: Introduction: About one-third of colorectal cancer surgery are performed as urgent surgery. This retrospective study aims to compare urgent surgery with patients those performed elective colorectal cancer surgery. Matherials and Methods: One hundred and sixty patients data those performed colorectal cancer surgery were analysed retrospectively. Patients were divided into two group; urgent surgery group (n=29) and elective surgery group (n=131). Demographics and clinicopathological features of the groups were compared. Results: There were no significant difference between groups in terms of age,blood transfusion requirement, additional surgical intervetion. Urgent surgery was performed more frequently in male patients .Urgent surgery has higher complication rates but no significant difference were observed in length of hospital stay. Total harvested lymph node number were similar between groups but in urgent surgery group metastatic lymph node number was significantly higher. Conclusion: Urgent colorectal resections for colorectal cancers can be performed with regarding the oncological principles
Elective surgery
Emergency Surgery
Colorectal Surgery
Cancer surgery
Demographics
Single Center
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