Dataset Information

Intraoperative adverse events as a risk factor for local recurrence of rectal cancer after resection surgery.

ABSTRACT:

Aim

Failure to achieve a radical resection as well as intraoperative rectal perforation are important risk factors for local recurrence after rectal cancer surgery, but the importance of other intraoperative adverse events for the prognosis is unknown. The aim of this study was to assess the occurrence of intraoperative adverse events during rectal cancer surgery, and to determine whether these were associated with an increased risk of local recurrence.

Methods

A retrospective population-based cohort study was undertaken, including all patients in Region Västra Götaland, Sweden, who had undergone primary resection surgery for rectal cancer diagnosed between 2010 and 2014, registered in the Swedish Colorectal Cancer Registry. Data were retrieved from the registry and through review of the medical records.

Results

In total, 1208 patients were included in the study of whom 78 (6%) developed local recurrence during the follow-up period of at least 5 years. Intraoperative adverse events were common and occurred in 62/78 (79%) of patients with local recurrence compared to 604/1130 (53%) of patients without local recurrence. In multivariate analysis intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer, as were nonradical resection, a high pathological T stage, the presence of lymph node metastases, type of surgery and refraining from rectal washout during anterior resection and Hartmann's procedure.

Conclusions

Intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer and could possibly be used together with other known risk factors to select patients for intensified postoperative surveillance.

SUBMITTER: Waldenstedt S

PROVIDER: S-EPMC9306731 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Adverse intraoperative events (AIEs) during surgery are a well-known entity. A better understanding of the incidence of AIEs and their relationship with outcomes is helpful for surgeon preparation and preoperative patient counseling. The goals of this study are to describe the incidence of AIEs during bariatric surgery and examine their impact on major adverse complications.The study included 5,882 subjects who had bariatric surgery in the Longitudinal Assessment of Bariatric Surgery study between March 2005 and April 2009. Prospectively collected AIEs included organ injuries, anesthesia-related events, anastomotic revisions, and equipment failure. The relationship between AIEs and a composite end point of 30-day major adverse complications (ie, death, venous thromboembolism, percutaneous, endoscopic, or operative reintervention and failure to be discharged from the hospital within 30 days from surgery) was evaluated using a multivariable relative risk model adjusting for factors known to influence their risk.There were 1,608 laparoscopic adjusted gastric banding, 3,770 laparoscopic Roux-en-Y gastric bypass operations, and 504 open Roux-en-Y gastric bypass operations. Adverse intraoperative events occurred in 5% of the overall sample and were most frequent during open Roux-en-Y gastric bypass (7.3%), followed by laparoscopic Roux-en-Y gastric bypass (5.5%) and laparoscopic adjusted gastric banding (3%). The rate of composite end point was 8.8% in the AIE group compared with 3.9% among those without an AIE (p < 0.001). Multivariable analysis revealed that patients with an AIE were at 90% greater risk of composite complication than those without an event (relative risk = 1.90; 95% CI, 1.26-2.88; p = 0.002), independent of the type of procedure (open or laparoscopic).Incidence of an AIE is not infrequent during bariatric surgery and is associated with much higher risk of major complication. Additional study is needed to assess the association between specific AIEs and short-term complications.

Project description:BackgroundRectal washout can prevent local recurrence after anterior resection of rectal cancer. Few studies have focused particularly on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer.ObjectiveTo estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer.Data sourcesRelevant studies were identified by a search of Medline, Embase, Wiley Online Library, China National Knowledge Infrastructure, Cochrane Oral Health Group Specialized Register, Wanfang databases and Google Website from their inception until October 18,2013.Study selectionStudies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included.InterventionsEligible studies used rectal washout. Control groups were defined as no washout.Study appraisal and synthesis methodsRandom-effects model were used to obtain summary estimates of RR and 95% CI, with Stata version 11 and RevMan 5.2.5 softwares used. The quality of report was appraised in reference to the MINORS item.ResultsOf the 919 rectal cancer patients in 8 included studies, a total of 61(6.64%) cases of local recurrence were reported, with a pooled RR 0.51 (95%CI = 0.28-0.92, P = 0.03). The RRs 0.37 and 0.39 in normal saline and washout volume (? 1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or ? 1500 ml in volume could significantly reduce local recurrence (LR) rate (95% CI = 0.17-0.79, P = 0.01; 95% CI = 0.18-0.87, P = 0.02) after anterior resection for cancer.LimitationThe included studies were non-randomized observational studies, with diversity of study designs.ConclusionRectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended.