Dataset Information

Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer.

ABSTRACT:

Background

The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival.

Methods

We conducted a retrospective case-control study in the National Cancer Center Hospital East, Japan. Patients who underwent colon interposition after esophagectomy for cancer between 2010 and 2020 were analyzed.

Results

Eighty-eight patients underwent esophagectomy with colon interposition; 53.2% received preoperative treatment and 52.3% underwent thoracoscopic surgery. Clavien-Dindo grade >III postoperative complications occurred in 42% of the patients; anastomotic leakage was the most common complication, occurring in 26.1% of the cases. Univariate analysis of the factors associated with Clavien-Dindo grade ConclusionIn colon reconstruction after esophageal cancer resection, totally mechanical Collard anastomosis for cervical anastomosis may reduce the risk of Clavien-Dindo grade >III complications.

SUBMITTER: Akutsu T

PROVIDER: S-EPMC8930463 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Publications

Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer.

Akutsu Tomohiro T Fujita Takeo T Kajiyama Daisuke D Ozaki Asako A Sato Kazuma K Fujiwara Hisashi H Kojima Takashi T Daiko Hiroyuki H

Thoracic cancer 20220127 6

<h4>Background</h4>The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival.<h4>Methods</h4>We conducted a retrospective case-control study in the National Cancer Center H ...[more]

PMID: 35088520

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Project description:Background:Both pre-operative anemia and perioperative (intra- and/or post-operative) blood transfusion have been reported to increase post-operative complications in patients with colon cancer undergoing colectomy. However, their joint effect has not been investigated. The purpose of this study was to evaluate the joint effect of pre-operative anemia and perioperative blood transfusion on the post-operative outcome of colon-cancer patients after colectomy. Methods:We identified patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006-2016 who underwent colectomy for colon cancer. Multivariate logistic regression analysis was employed to assess the independent and joint effects of anemia and blood transfusion on patient outcomes. Results:A total of 35,863 patients-18,936 (52.8%) with left-side colon cancer (LCC) and 16,927 (47.2%) with right-side colon cancer (RCC)-were identified. RCC patients were more likely to have mild anemia (62.7%) and severe anemia (2.9%) than LCC patients (40.2% mild anemia and 1.4% severe anemia). A total of 2,661 (7.4%) of all patients (1,079 [5.7%] with LCC and 1,582 [9.3%] with RCC) received a perioperative blood transfusion. Overall, the occurrence rates of complications were comparable between LCC and RCC patients (odds ratio [OR]?=?1.01; 95% confidence interval [CI]?=?0.95-1.07; P?=?0.750). There were significant joint effects of anemia and transfusion on complications and the 30-day death rate (P for interaction: 0.010). Patients without anemia who received a transfusion had a higher risk of any complications (LCC, OR?=?3.51; 95% CI?=?2.55-4.85; P?<?0.001; RCC, OR?=?3.74; 95% CI?=?2.50-5.59; P?<?0.001), minor complications (LCC, OR?=?2.54; 95% CI?=?1.63-3.97; P?<?0.001; RCC, OR?=?2.27; 95% CI?=?1.24-4.15; P?=?0.008), and major complications (LCC, OR?=?5.31; 95% CI?=?3.68-7.64; P?<?0.001; RCC, OR?=?5.64; 95% CI?=?3.61-8.79; P?<?0.001), and had an increased 30-day death rate (LCC, OR?=?6.97; 95% CI?=?3.07-15.80; P?<?0.001; RCC, OR?=?4.91; 95% CI?=?1.88-12.85; P?=?0.001) than patients without anemia who did not receive a transfusion. Conclusions:Pre-operative anemia and perioperative transfusion are associated with an increased risk of post-operative complications and increased death rate in colon-cancer patients undergoing colectomy.

Project description:INTRODUCTION:Patients undergoing ileostomy surgery often experience electrolyte disturbances and dehydration, especially during the first post-operative period. Recently, research has also begun on how the newly constructed ileostomy affects the patient's nutritional status. AIM:The aim of the present pilot study was to assess the nutritional status of patients before and after the construction of the ileostomy as well as nutrition-related factors. MATERIAL AND METHOD:This was a pilot study. The sample consisted of 13 adult patients diagnosed with colorectal or colon cancer who underwent scheduled ileostomy surgery. The evaluation tool used was "Original Full Mini Nutritional Assessment (MNA)". Patients underwent nutritional assessment before the surgery (time 0), on the 7th post-operative day (time 1), and on the 20th post-operative day (time 2). The statistical significance level was set at p < 0.05. RESULTS:All patients had a drop in MNA score on the 7th and 20th post-operative days. Factors associated with MNA were weight loss, mobility, body mass index (BMI), number of full meals consumed per day, portions of fruits and vegetables consumed per day, and mid-arm circumference, p < 0.05, respectively. Pre-operatively, 38.5%, of patients had severe weight loss (>3 kg), 23% moderate weight loss and 38.5% minimal weight loss. Pre-operatively, 92.3% of participants were able to move on their own and 69.2% on the 20th post-operatively day. Furthermore, BMI >23 kg/m2 had 84.6% of participants pre-operatively and 30.8% on the 20th post-operative day. In terms of portions of fruits and vegetables consumed per day, 30.8% of patients consumed at least 2 times, pre-operatively and no one (0%) on the 20th post-operative day. Moreover, pre-operatively all participants (100%) had arm circumference >22 cm while on the 20th post-operative day, only 38.5% of participants had arm circumference >22 cm. CONCLUSIONS:In the first 20 days after the construction of an ileostomy, the nutritional status of the patients is significantly affected. Decreased patient nutrition in both quantity and ingredients and reduced fluid intake appear to adversely affect the patient's nutritional status.

Dataset Information

Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer.

Background

Methods

Results

Publications

Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer.

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