Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10–27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial.
The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer.
A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission).
In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors.
This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.
Surgery is associated with a high risk for morbidity and mortality, particularly when performed in critical patients requiring intensive care unit (ICU) admission.
The aim of this study was to investigate risk factors associated with adverse outcomes in a large cohort of patients admitted to a single-center ICU after abdominal surgery.
All patients admitted to a surgical ICU for postoperative care, from January 2016 to December 2022, were retrospectively evaluated. Data concerning demographics and clinical and perioperative variables were compared to in-hospital mortality.
A total of 1,717 patients (1,096 women, mean age: 61±17 years) were evaluated. Most of the patients underwent colorectal (n=499), pancreatic (n=148), biliary tract (n=147), and gastric surgeries (n=145); liver resection (n=131); and several gynecological or obstetric procedures (n=250). Only 52.3% of these surgical procedures were elective. The mean Charlson Comorbidity Index (CCI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were 4.4±2.8 and 10.1±5.6, respectively. Mortality was observed in 158 (9.2%) patients. Age (70.4±14.3 vs. 60.6±17.1 years in survivors, p=0.002), CCI (6.1±2.5 vs. 4.3±2.8 in survivors, p=0.005), type of surgery (13.6% in emergent/urgent vs. 5.5% in elective surgeries, p<0.001), and APACHE II score (16.7±8.4 vs. 9.4±4.7 in survivors, p<0.0001) were associated with mortality on univariate analysis, but only CCI, type of surgery, and APACHE II score were independently correlated with a higher risk of death on multivariate analysis.
Mortality after abdominal surgery in patients requiring postoperative ICU support is less than 10% nowadays, and it is independently associated with urgent or emergent surgeries, disease severity, and comorbidity.
Hepatectomy is historically associated with higher morbidity and mortality, related to intraoperative blood loss and biliary fistulas. Technological advances and improvements in surgical and anesthetic techniques have led to greater safety in performing these surgeries.
The aim of this study was to analyze morbidity and mortality in patients undergoing hepatectomy.
Retrospective cohort study of patients undergoing liver resections. The type of hepatectomy, indications, need for intraoperative blood transfusion, hospital stay, complications, and postoperative mortality were analyzed.
A total of 48 hepatectomies were performed during the studied period, the most common being 26 (54.16%) major hepatectomies, distributed among 13 (50%) left hepatectomies, 11 (42.30%) right hepatectomies, and 2 (7.70%) others. In total, 24 (45.84%) minor hepatectomies were performed, 11 (50%) mono segmentectomies, and 5 (22.72%) left lateral hepatectomies. The main indications for resection in benign diseases were 6 (12.50%) neotropical hepatic hydatidosis, five (10.41%) intrahepatic lithiasis, and in primary malignancies, 9 (18.75%) hepatocarcinomas. There was no need for an intraoperative blood transfusion. Hospital stays after surgery ranged from 2 to 40 days (average=7 days), and 41 (85.42%) patients went to the ICU in the first 72 h after surgery. In total, 9 (18.75%) patients developed postoperative complications. Overall mortality was 2.08%.
Hepatocellular carcinoma and neotropical hydatidosis were the main diseases with surgical indication, and major hepatectomies were the most performed procedures. Morbidity and mortality were in line with results from major global centers.
Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer.
We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia.
This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia’s contributory health system between 2012 and 2017. We defined exposure as the hospital’s surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates.
The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality.
The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.
Small bowel obstruction (SBO) is a major problem in emergencies. Comorbidities increase morbimortality, which is reflected in higher costs. There is a lack of Latin American evidence comparing the differences in postoperative results and costs associated with SBO management.
To compare the risk of surgical morbimortality and costs of SBO surgery treatment in patients older and younger than 80 years.
Retrospective analysis of patients diagnosed with SBO at the University of Chile Clinic Hospital from January 2014 to December 2017. Patients with any medical treatment were excluded. Parametric statistics were used (a 5% error was considered statistically significant, with a 95% confidence interval).
A total of 218 patients were included, of which 18.8% aged 80 years and older. There were no differences in comorbidities between octogenarians and non-octogenarians. The most frequent etiologies were adhesions, hernias, and tumors. In octogenarian patients, there were significantly more complications (46.3 vs. 24.3%, p=0.007, p<0.050). There were no statistically significant differences in terms of surgical complications: 9.6% in <80 years and 14.6% in octogenarians (p=0.390, p>0.050). In medical complications, a statistically significant difference was evidenced with 22.5% in <80 years vs 39.0% in octogenarians (p=0.040, p<0.050). There were 20 reoperated patients: 30% octogenarians and 70% non-octogenarians without statistically significant differences (p=0.220, p>0.050). Regarding hospital stay, the average was significantly higher in octogenarians (17.4 vs. 11.0 days; p=0.005, p<0.050), and so were the costs, being USD 9,555 vs. USD 4,214 (p=0.013, p<0.050).
Patients aged 80 years and older with surgical SBO treatment have a higher risk of medical complications, length of hospital stay, and associated costs compared to those younger.
Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated.
To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity.
Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity.
The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis.
Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.
The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible.
To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique.
From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor.
Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service.
The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.
It is known that elective inguinal hernioplasties are safe procedures, but in an emergency setting, they have higher rates of complications and hospital costs. Despite this, quantitative studies on the subject in Brazil are still scarce.
To evaluate the trend in hospitalization rates, hospital mortality, and costs for inguinal hernia in an emergency, regarding gender and age group.
This is a time series study with data from the Unified Health System (SUS), at the national level, from 2010 to 2019.
The overall hospitalization rate (p=0.007; b<0,02) in all age groups (p<0.005; b<0) in both genders indicated a decreasing trend. The general mortality rate in both genders and in most age groups showed an increasing trend (p<0.005), as well as the cost of hospitalization in all age groups of both genders.
Urgent hospitalization rates for inguinal hernia in Brazil have shown a steady or decreasing trend; however, hospital mortality and costs per hospitalization have demonstrated an increasing trend in recent years.
Small bowel obstruction (SBO) is a frequent cause of emergency department admissions.
This study aimed to determine risk factors of reoperations, postoperative adverse event, and operative mortality (OM) in patients surgically treated for SBO.
This is a retrospective study conducted between 2014 and 2017. Exclusion criteria include gastric outlet obstruction, large bowel obstruction, and incomplete clinical record. STATA version 14 was used for statistical analysis, with p-value <0.05 with 95% confidence interval considered statistically significant.
A total of 218 patients were included, in which 61.9% were women. Notably, 88.5% of patients had previous abdominal surgery. Intestinal resection was needed in 28.4% of patients. Postoperative adverse event was present in 28.4%, reoperation was needed in 9.2% of cases, and a 90-day surgical mortality was 5.9%. Multivariate analysis determined that intestinal resection, >3 days in intensive care unit (ICU), >7 days with nasogastric tube (NGT), pain after postoperative day 3, POAE, and surgical POAE were the risk factors for reoperations, while age, C-reactive protein, intestinal resection, >3 days in ICU, and >7 days with NGT were the risk factors for POAE. OM was determined by >5 days with NGT and POAE.
Postoperative course is determined mainly for patient’s age, preoperative level of C-reactive protein, necessity of intestinal resection, clinical postoperative variables, and the presence of POAE.
Colorectal cancer generally metastasizes to the liver. Surgical resection of liver metastasis, which is associated with systemic chemotherapy, is potentially curative, but many patients will present recurrence. In selected patients, repeated hepatectomy is feasible and improves overall survival.
This study aimed to analyze patients with colorectal liver metastasis (CRLM) submitted to hepatectomy in three centers from Rio de Janeiro, over the past 10 years, by comparing the morbidity of first hepatectomy and re-hepatectomy.
From June 2009 to July 2020, 192 patients with CRLM underwent liver resection with curative intent in three hospitals from Rio de Janeiro Federal Health System. The data from patients, surgeries, and outcomes were collected from a prospectively maintained database. Patients submitted to first and re-hepatectomies were classified as Group 1 and Group 2, respectively. Data from groups were compared and value of p<0.05 was considered significant.
Among 192 patients, 16 were excluded. Of the remaining 176 patients, 148 were included in Group 1 and 28 were included in Group 2. Fifty-five (37.2%) patients in Group 1 and 13 (46.5%) in Group 2 presented postoperative complications. Comparing Groups 1 and 2, we found no statistical difference between the cases of postoperative complications (p=0.834), number of minor (p=0.266) or major (p=0.695) complications, and deaths (p=0.407).
No differences were recorded in morbidity or mortality between patients submitted to first and re-hepatectomies for CRLM, which reinforces that re-hepatectomy can be performed with outcomes comparable to first hepatectomy.
Desenvolvido por Surya MKT