Diseases of the colon and rectum
-
Meta-analyses of randomized controlled trials support the use of laparoscopically assisted resection for colon cancer. The evidence supporting its use in rectal cancer is weak. ⋯ Despite increases in laparoscopically assisted resections for colon and rectal cancer, the majority of resections are still treated by open procedures. Our data suggest that laparoscopic resection reduces the lengths of stay and rates of readmission and may result in improved cancer-specific survival for both colon and rectal resections.
-
There is evidence demonstrating an association between infection and venous thromboembolism. We recently identified this association in the postoperative setting; however, the temporal relationship between infection and venous thromboembolism is not well defined ⋯ These findings of a temporal association between infection and venous thromboembolism suggest a potential early indicator for using certain postoperative infectious complications as clinical warning signs that a patient is more likely to develop venous thromboembolism. Further studies into best practices for prevention are warranted.
-
Extranodal tumor deposits are involved in TNM classification. However, it is uncertain whether a tumor deposit is a regular lymph node metastasis, and its prognostic significance in patients with stage II or III colorectal cancer remains to be established. ⋯ Tumor deposit may be an independent adverse prognostic factor for stage II and III N1 colorectal cancer.
-
Despite laparoscopy and enhanced recovery pathways, some patients do not attain early discharge. Frailty is generally accepted as a marker of increased risk, complications, and mortality. Frailty may have the potential to identify patient outcomes. ⋯ Patients undergoing elective colorectal surgery with a higher Modified Frailty Index were more likely not to attain early discharge. Despite similar demographics, the Modified Frailty Index could discriminate between patient outcomes, and correlated with longer operating times, length of stay, and readmissions. By using a prospective score to identify patients at risk for not achieving early discharge preoperatively, resources and postoperative support can be better allocated.