Factors associated with survival after resection of colorectal adenocarcinoma in 314 patients. 2012

J Carlisle, and M Swart, and E J C Dawe, and M Chadwick
Department of Anaesthetics, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Lawes Bridge, Torquay, Devon TQ2 7AA, UK. john.carlisle@nhs.net

BACKGROUND An analysis of perioperative factors that were independently associated with survival up to 1000 days after scheduled colorectal adenocarcinoma resections in 314 patients. METHODS The association of 16 perioperative variables with postoperative survival and critical care unit (CCU) admission after scheduled resections for colorectal adenocarcinoma between September 2005 and March 2009 was analysed using multivariable Cox regression analyses and Fisher's exact tests. RESULTS We followed survivors for a mean of 983 days (range 696-1000 days). Average annual postoperative mortality was 8.5%, 14% after surgery performed in 2005, and 3% after surgery in 2009. Risk of mortality was independently associated with five variables after stratifying for date of surgery: attending a preoperative high-risk clinic [hazard ratio (HR) 0.42, P=0.006], worse World Health Organization performance status (HR 2.1, P=0.001), BMI (HR 0.92, P=0.009), higher nodal stage (HR 2.6, P<0.0001), and unplanned critical care admission (HR 7.2, P<0.0001). Patients who attended the preoperative clinic (207) were older, with worse renal function and ASA grade, than those who did not (107). Planned postoperative critical care admission was more common in patients who attended the high-risk clinic (24% vs 12%, P=0.01) and may have partly accounted for the observed mortality difference. CONCLUSIONS Immediate perioperative care may have prolonged effects on postoperative survival. Specialized preoperative assessment clinics may reduce mortality after colorectal surgery.

UI MeSH Term Description Entries
D007362 Intensive Care Units Hospital units providing continuous surveillance and care to acutely ill patients. ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D008207 Lymphatic Metastasis Transfer of a neoplasm from its primary site to lymph nodes or to distant parts of the body by way of the lymphatic system. Lymph Node Metastasis,Lymph Node Metastases,Lymphatic Metastases,Metastasis, Lymph Node
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010044 Outpatient Clinics, Hospital Organized services in a hospital which provide medical care on an outpatient basis. Ambulatory Care Facilities, Hospital,Hospital Outpatient Clinics,Clinic, Hospital Outpatient,Clinics, Hospital Outpatient,Hospital Outpatient Clinic,Outpatient Clinic, Hospital
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D003082 Colectomy Surgical resection of a portion of or the entire colon. Hemicolectomy,Large Bowel Resection,Colectomies,Hemicolectomies,Large Bowel Resections,Resection, Large Bowel,Resections, Large Bowel
D004812 Epidemiologic Methods Research techniques that focus on study designs and data gathering methods in human and animal populations. Epidemiologic Method,Epidemiological Methods,Methods, Epidemiologic,Epidemiological Method,Method, Epidemiologic,Method, Epidemiological,Methods, Epidemiological
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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