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Kırılganlık İndeksinin Tıkayıcı ve Perfore Kolon Kanseri İçin Yapılan Acil Kolektomi Sonuçları Üzerine Etkisi

Year 2022, Volume: 9 Issue: 3, 231 - 237, 30.12.2022

Nadir Adnan Hacım Merve Tokocin Serhat Meric Talar Vartanoglu Aktokmakyan Soon Sup Chung Yunus Aktimur Haşim Furkan Güllü Yuksel Altınel

https://doi.org/10.47572/muskutd.952817

Abstract

Bu çalışma ile tıkayıcı ve perfore kolon kanseri nedeniyle acil cerrahi geçiren hastalarda kırılganlık indeksinin ameliyat sonuçları üzerine prediktif etkisini araştırmayı amaçladık. Şubat 2017 ile Ekim 2020 tarihleri arasında, tümörün tıkanması veya perforasyonu nedeniyle acil sağ ve sol hemikolektomi yapılan doksan-dokuz hasta retrospektif olarak değerlendirildi. 5-mFI skoru (modified frailty index), kırılganlık özelliklerinin her bir sayısının değerlendirmesiyle ölçüldü (her biri 1 puan; 0-5 puan) ve üç gruba ayrıldı (mFI=0, mFI=1 ve mFI≥2). Hasta popülasyonunun ortalama yaşı 65.21±13.84 idi. Erkek hastalar 60 (%60) idi. Daha yüksek mFI olan hastalarda albümin düzeyi daha düşük saptandı (3.86±0.63 vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). Artan mFI ile doğru orantıda, Clavien Dindo sınıflamması (CDC) [OR: 1.49,%95 CI: 0.82-2.75, p=0.2], morbidite [OR: 2.43,%95 CI: 0.50-13.98, p=0.3] ve anastomoz kaçağı [OR: 2,02,%95 CI: 0,63-6,65, p=0,2] artmış olduğu tespit edildi. Morbidite (16,%24.6 vs. 16,%47.1), p=0.041) ve mortalite (10,%15.4 vs. 9,%26.5, p=0.289) sağ kolon kanseri için daha fazla oranda görüldü. Stoma oluşumu genellikle sol taraf kolon kanserli hastalarda izlendi (29,%60 vs. 8,%23.5, p=0.001). 5-mFI skoru; morbidite, mortalite, uzun süre hastanede kalış ve reoperasyonlar dikkate alınarak acil kolon cerrahisi bulguları için muhtemel bir preoperatif prognostik belirteç olarak düşünülebilinir. Sağ taraflı tümörlerde morbidite ve mortalite ve sol taraflı tümörlerde stoma oluşumu daha artmış görülmeşine rağmen, 5-mFI skoru hastalarda kolon kanser yerleşim yerine bağımlı olmadan değerlendirilebilir.

Keywords

Kırılganlık Kolektomi Acil

References

  • 1. Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83.
  • 2. MacKenzie S, Thomson SR, Baker LW. Management options in malignant obstruction of the left colon. Surg Gynecol Obstet. 1992;174:337–45.
  • 3. Crowder VHJ, Cohn IJ. Perforation in cancer of the colon and rectum Dis Colon Rectum. 1967;10:415–20.
  • 4. McGregor JR, O’Dwyer PJ. The surgical management of obstruction and perforation of the left colon. Surg Gynecol Obstet. 1993;177:203–8.
  • 5. Kızıltan R, Yılmaz Ö, Aras A, et al. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer. Med Glas. 2016;13:62–7.
  • 6. Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017;15:164.
  • 7. Al-Khamis A, Warner C, Park J, et al. Modified frailty index predicts early outcomes after colorectal surgery: an ACS-NSQIP study. Colorectal Dis. 2019;21:1192-205.
  • 8. Vermillion SA, Hsu FC, Dorrell RD et. al. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115:997–1003.
  • 9. Velanovich V, Antoine H, Swartz A, et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:104–10.
  • 10. Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc. 2017;31: 2509-19.
  • 11. Chen SY, Stem M, Cerullo M, et al. The effect of frailty index on early outcomes after combined colorectal and liver resections. J Gastrointest Surg. 2018;22: 640–9.
  • 12. Grass F, Lovely JK, Crippa J, et al. Comparison of recovery and outcome after left and right colectomy. Colorectal Dis. 2019;21:481-6.
  • 13. Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg. 2001;192:719-25.
  • 14. Faucheron JL, Paquette B, Trilling B, et al. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg. 2018;44:71-7.
  • 15. Tan K-K, Sim R. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg. 2010;14:295–302.
  • 16. Biondo S, Gálvez A, Ramírez E, et al. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol. 2019;23:1141-61.
  • 17. Campana JP, Pellegrini PA, Rossi GL, et al. Right versus left laparoscopic colectomy for colon cancer: does side make any difference? Int J Colorectal Dis. 2017;32:907–12.
  • 18. Wagner D, DeMarco MM, Amini N, et al. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg. 2016;8:27–40.
  • 19. Congiusta DV, Palvannan P, Merchant AM. The impact of frailty on morbidity and mortality following open emergent colectomies. Biomed Res Int. 2017;2017:5126452.
  • 20. Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190(3):376–82.
  • 21. Simon HL, Reif de Paula T, Profeta da Luz MM, et al. Frailty in older patients undergoing emergency colorectal surgery: USA National Surgical Quality Improvement Program analysis. Br J Surg. 2020;107:1363-71.
  • 22. Kothari P, Congiusta DV, Merchant AM. Laparoscopic versus open colectomy: the impact of frailty on outcomes. Updates Surg. 2019;71:89-96.
  • 23. Pandit V, Khan M, Martinez C, et al. A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention. Am J Surg. 2018;216:1090-4.
  • 24. Sparreboom CL, van Groningen JT, Lingsma HF, et al. Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit. Dis Colon Rectum. 2018;61:1258-66.
  • 25. Chen SY, Stem M, Gearhart SL, et al. Functional dependence versus frailty in gastrointestinal surgery: Are they comparable in predicting short-term outcomes? Surgery. 2018;164:1316-24.
  • 26. Chen SY, Stem M, Cerullo M, et al. The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections. J Gastrointest Surg. 2018;22:640-9.

The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer

Year 2022, Volume: 9 Issue: 3, 231 - 237, 30.12.2022

Nadir Adnan Hacım Merve Tokocin Serhat Meric Talar Vartanoglu Aktokmakyan Soon Sup Chung Yunus Aktimur Haşim Furkan Güllü Yuksel Altınel

https://doi.org/10.47572/muskutd.952817

Abstract

This study aimed to analyze the predictive impact of frailty index and patterns of outcomes in patients with obstructing and perforated colon cancer who had emergency surgery. The nighty-nine patients who underwent right and left hemicolectomy were retrospectively evaluated within emergency conditions such as obstruction or perforation of tumor between February 2017 and October 2020. The 5-mFI (modified frailty index) score was measured by multiplying each number of frailty features (1 point per each existence; 0 - 5 points) and categorized into three groups (mFI=0, mFI=1, and mFI ≥ 2). The average age of the patient population was 65.21±13.84 years old. The male patients were 60 (60%). Albumin level was seen lower in patients who had higher mFI (3.86±0.63vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). The predictive outcomes regarding the mFI potentially showed increased Clavien Dindo classification (CDC) [OR: 1.49, 95%CI: 0.82-2.75, p=0.2], morbidity [OR: 2.43, 95%CI: 0.50-13.98, p=0.3], and leakage [OR: 2.02, 95%CI: 0.63-6.65, p=0.2]. The morbidity (16, 24.6% vs. 16, 47.1%), p=0.041) and mortality (10, 15.4% vs. 9, 26.5%, p=0.289) were more likely seen for right sided tumors. Stoma formation was seen more likely for left sided tumors (29, 60% vs. 8, 23.5%, p=0.001). The 5-mFI score might be assumed as a preoperative prognostic tool for emergency colon surgery considering morbidity, mortality, prolonged hospitalization, and reoperation. Although morbidity and mortality in right-sided tumors and stoma formation are higher in left-sided tumors, 5-mFI score can be evaluated in patients regardless of colon cancer location.

Keywords

Frailty Colectomy Emergency

References

  • 1. Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83.
  • 2. MacKenzie S, Thomson SR, Baker LW. Management options in malignant obstruction of the left colon. Surg Gynecol Obstet. 1992;174:337–45.
  • 3. Crowder VHJ, Cohn IJ. Perforation in cancer of the colon and rectum Dis Colon Rectum. 1967;10:415–20.
  • 4. McGregor JR, O’Dwyer PJ. The surgical management of obstruction and perforation of the left colon. Surg Gynecol Obstet. 1993;177:203–8.
  • 5. Kızıltan R, Yılmaz Ö, Aras A, et al. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer. Med Glas. 2016;13:62–7.
  • 6. Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017;15:164.
  • 7. Al-Khamis A, Warner C, Park J, et al. Modified frailty index predicts early outcomes after colorectal surgery: an ACS-NSQIP study. Colorectal Dis. 2019;21:1192-205.
  • 8. Vermillion SA, Hsu FC, Dorrell RD et. al. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115:997–1003.
  • 9. Velanovich V, Antoine H, Swartz A, et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:104–10.
  • 10. Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc. 2017;31: 2509-19.
  • 11. Chen SY, Stem M, Cerullo M, et al. The effect of frailty index on early outcomes after combined colorectal and liver resections. J Gastrointest Surg. 2018;22: 640–9.
  • 12. Grass F, Lovely JK, Crippa J, et al. Comparison of recovery and outcome after left and right colectomy. Colorectal Dis. 2019;21:481-6.
  • 13. Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg. 2001;192:719-25.
  • 14. Faucheron JL, Paquette B, Trilling B, et al. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg. 2018;44:71-7.
  • 15. Tan K-K, Sim R. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg. 2010;14:295–302.
  • 16. Biondo S, Gálvez A, Ramírez E, et al. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol. 2019;23:1141-61.
  • 17. Campana JP, Pellegrini PA, Rossi GL, et al. Right versus left laparoscopic colectomy for colon cancer: does side make any difference? Int J Colorectal Dis. 2017;32:907–12.
  • 18. Wagner D, DeMarco MM, Amini N, et al. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg. 2016;8:27–40.
  • 19. Congiusta DV, Palvannan P, Merchant AM. The impact of frailty on morbidity and mortality following open emergent colectomies. Biomed Res Int. 2017;2017:5126452.
  • 20. Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190(3):376–82.
  • 21. Simon HL, Reif de Paula T, Profeta da Luz MM, et al. Frailty in older patients undergoing emergency colorectal surgery: USA National Surgical Quality Improvement Program analysis. Br J Surg. 2020;107:1363-71.
  • 22. Kothari P, Congiusta DV, Merchant AM. Laparoscopic versus open colectomy: the impact of frailty on outcomes. Updates Surg. 2019;71:89-96.
  • 23. Pandit V, Khan M, Martinez C, et al. A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention. Am J Surg. 2018;216:1090-4.
  • 24. Sparreboom CL, van Groningen JT, Lingsma HF, et al. Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit. Dis Colon Rectum. 2018;61:1258-66.
  • 25. Chen SY, Stem M, Gearhart SL, et al. Functional dependence versus frailty in gastrointestinal surgery: Are they comparable in predicting short-term outcomes? Surgery. 2018;164:1316-24.
  • 26. Chen SY, Stem M, Cerullo M, et al. The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections. J Gastrointest Surg. 2018;22:640-9.
There are 26 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Article
Authors

Nadir Adnan Hacım 0000-0002-3906-2538

Merve Tokocin 0000-0001-8040-300X

Serhat Meric 0000-0001-7660-5688

Talar Vartanoglu Aktokmakyan 0000-0003-0583-6440

Soon Sup Chung This is me 0000-0003-0921-8228

Yunus Aktimur This is me 0000-0002-8124-5522

Haşim Furkan Güllü 0000-0003-3004-1471

Yuksel Altınel 0000-0003-0113-4839

Publication Date December 30, 2022
Submission Date June 19, 2021
Published in Issue Year 2022 Volume: 9 Issue: 3

Cite

APA Hacım, N. A., Tokocin, M., Meric, S., Vartanoglu Aktokmakyan, T., et al. (2022). The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 9(3), 231-237. https://doi.org/10.47572/muskutd.952817
AMA Hacım NA, Tokocin M, Meric S, Vartanoglu Aktokmakyan T, Chung SS, Aktimur Y, Güllü HF, Altınel Y. The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer. MMJ. December 2022;9(3):231-237. doi:10.47572/muskutd.952817
Chicago Hacım, Nadir Adnan, Merve Tokocin, Serhat Meric, Talar Vartanoglu Aktokmakyan, Soon Sup Chung, Yunus Aktimur, Haşim Furkan Güllü, and Yuksel Altınel. “The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 9, no. 3 (December 2022): 231-37. https://doi.org/10.47572/muskutd.952817.
EndNote Hacım NA, Tokocin M, Meric S, Vartanoglu Aktokmakyan T, Chung SS, Aktimur Y, Güllü HF, Altınel Y (December 1, 2022) The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 9 3 231–237.
IEEE N. A. Hacım, “The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer”, MMJ, vol. 9, no. 3, pp. 231–237, 2022, doi: 10.47572/muskutd.952817.
ISNAD Hacım, Nadir Adnan et al. “The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 9/3 (December 2022), 231-237. https://doi.org/10.47572/muskutd.952817.
JAMA Hacım NA, Tokocin M, Meric S, Vartanoglu Aktokmakyan T, Chung SS, Aktimur Y, Güllü HF, Altınel Y. The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer. MMJ. 2022;9:231–237.
MLA Hacım, Nadir Adnan et al. “The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 9, no. 3, 2022, pp. 231-7, doi:10.47572/muskutd.952817.
Vancouver Hacım NA, Tokocin M, Meric S, Vartanoglu Aktokmakyan T, Chung SS, Aktimur Y, Güllü HF, Altınel Y. The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer. MMJ. 2022;9(3):231-7.
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