BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in prev...BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.展开更多
BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic ...BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.展开更多
BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer(CRC)surgery.While probiotics have been pro-posed as a potential strategy to mitigate the risk of...BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer(CRC)surgery.While probiotics have been pro-posed as a potential strategy to mitigate the risk of these infections,contemporary meta-analyses have produced conflicting findings.AIM To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery.METHODS A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024.To assess the efficacy of probiotics on outcomes,relative risks(RR)and their corresponding 95%CI were pooled using a random effects model.RESULTS This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria.Probiotics administration resulted in a statistically significant reduction in the incidence of total infections(RR:0.40,95%CI:0.31-0.51;moderate certainty),surgical site infections(RR:0.56,95%CI:0.49-0.63;high certainty),pneumonia(RR:0.38,95%CI:0.30-0.48;high certainty),urinary tract infections(RR:0.44,95%CI:0.31-0.61;moderate certainty),bacteremia(RR:0.41,95%CI:0.30-0.56;high certainty),and sepsis(RR:0.35,95%CI:0.25-0.44;high certainty).However,probiotics did not significantly affect intra-abdominal,central line,or peritoneal infections.CONCLUSION Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.展开更多
AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cance...AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.展开更多
BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surg...BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.展开更多
BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outc...BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.展开更多
Objective:To explore the therapeutic effect of laparoscopic radical colorectal cancer treatment in colorectal cancer patients.Methods:A total of 50 colorectal cancer patients treated between August 2018 and August 202...Objective:To explore the therapeutic effect of laparoscopic radical colorectal cancer treatment in colorectal cancer patients.Methods:A total of 50 colorectal cancer patients treated between August 2018 and August 2023 were randomly divided into two groups:Group A underwent laparoscopic radical colorectal cancer surgery,while Group B received open surgery.Clinical indicators,inflammatory factors,immune function indicators,and complications were compared between the two groups.Results:Group A showed significantly shorter operation times,faster recovery times,and reduced hospital stays compared to Group B.Additionally,Group A had less abdominal drainage and intraoperative bleeding(P<0.05).Levels of interleukin(IL)-4,IL-6,ultrasensitive C-reactive protein(hs-CRP),and tumor necrosis factor-alpha(TNF-α)were lower in Group A compared to Group B(P<0.05).Furthermore,immune function indicators,including CD3+,CD4+,CD8+,and CD4+/CD8+ratios,were better in Group A(P<0.05).The complication rate in Group A was also lower than in Group B(P<0.05).Conclusion:Laparoscopic radical treatment for colorectal cancer is efficient and feasible,causing minimal immune function impairment and inflammatory response.It also shortens postoperative recovery time.展开更多
AIM:To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.METHODS:We retrospectively examined all patients affected by colore...AIM:To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.METHODS:We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department.Our evaluation criteria were:diagnosis of colorectal carcinoma at presurgical biopsy,elective surgery,and the same surgeon.We excluded:emergency surgery,conversions from laparotomic colectomy,and other surgeons.The endpoints we examined were:surgical time,number of lymph nodes removed,length of stay(removal of nasogastric tube,bowel movements,gas evacuation,solid and liquid feeding,hospitalization),and major complications.Seventy-two patients were divided into two groups:intracorporeal anastomosis(39 patients)and extracorporeal anastomosis(33 patients).RESULTS:Significant differences were observed between intracorporeal vs extracorporeal anastomosis,respectively,for surgical times(186.8 min vs 184.1 min,P < 0.001),time to resumption of gas evacuation(3 d vs 3.5 d,P < 0.001),days until resumption of bowel movements(3.8 d vs 4.9 d,P < 0.001),days until resumption of liquid diet(3.5 d vs 4.5 d,P < 0.001),days until resuming a solid diet(4.6 d vs 5.7 d,P < 0.001),and total hospitalization duration(7.4 d vs 8.5 d,P < 0.001).In the intracorporeal group,on average,19 positive lymph nodes were removed;in the extracorporeal group,on average,14 were removed P < 0.001).Thus,intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition,faster recovery of intestinal function,and shorter hospitalization than extracorporeal anastomosis.CONCLUSION:Short-term outcomes favor intracorporeal anastomosis,confirming that a less traumatic surgical approach improves patient outcome.展开更多
AIM： To evaluate the usefulness of three-dimensional computed tomography （3DCT） in laparoscopic surgery for colorectal carcinoma. METHODS： Seventy-two patients with colorectal cancer who underwent curative operati...AIM： To evaluate the usefulness of three-dimensional computed tomography （3DCT） in laparoscopic surgery for colorectal carcinoma. METHODS： Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group （LG）, while 56 patients underwent conventional open surgery, open group （OG）. At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery （IMA） by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery （SMA）/superior mesenteric vein （SMV）, ileocecal artery （ICA）, middle colic artery （MCA）, and inferior mesenteric vein （IMV）. We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS： The mean length of the incision in LG was 4.6254-0.89 cm, which was significantly shorter than that in OG （P〈0.001）. The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage.CONCLUSION： Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma.展开更多
BACKGROUND Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer.Traditional Chinese medicine has advantages,including safety and stability,for the treatment of...BACKGROUND Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer.Traditional Chinese medicine has advantages,including safety and stability,for the treatment of intestinal colic.Lamp irra-diation for abdominal ironing has been applied in the treatment of many gas-trointestinal diseases.Purple gromwell oil has the effects of clearing heat,cooling blood,reducing swelling,and relieving pain.RESULTS The general effective rate in the observation group was 95.00%,which was significantly higher than that in the control group(86.67%,P<0.05).Before treatment,there was no significant difference in the duration of symptoms between the groups(P>0.05).After 1,2,3,and 4 d of treatment,the duration of symptoms in both groups were decreased,and the duration in the observation group was significantly lower than that in the control group(96.54±9.57 vs 110.45±11.23,87.26±12.07 vs 104.44±11.68,80.45±16.21 vs 99.44±14.95,73.18±15.58 vs 92.17±14.20;P<0.05).After 1,3,5,and 7 d of treatment,the NRS scores in both groups were decreased,and the NRS scores in the observation group were significantly lower than those in the control group(3.56±0.41 vs 4.04±0.58,3.07±0.67 vs 3.74±1.02,2.52±0.76 vs 3.43±0.85,2.03±0.58 vs 3.03±0.82;P<0.05).There was no significant difference in the rate of adverse reaction occurrence between the groups(P>0.05).CONCLUSION The use of lamp irradiation combined with purple gromwell oil gauze in patients with intestinal colic after radical surgery for colorectal cancer can reduce symptom duration,alleviate intestinal colic,and improve treatment efficacy,and this approach is safe.It is worth promoting the use of this treatment in clinical practice.展开更多
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
文摘BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.
文摘BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.
文摘BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer(CRC)surgery.While probiotics have been pro-posed as a potential strategy to mitigate the risk of these infections,contemporary meta-analyses have produced conflicting findings.AIM To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery.METHODS A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024.To assess the efficacy of probiotics on outcomes,relative risks(RR)and their corresponding 95%CI were pooled using a random effects model.RESULTS This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria.Probiotics administration resulted in a statistically significant reduction in the incidence of total infections(RR:0.40,95%CI:0.31-0.51;moderate certainty),surgical site infections(RR:0.56,95%CI:0.49-0.63;high certainty),pneumonia(RR:0.38,95%CI:0.30-0.48;high certainty),urinary tract infections(RR:0.44,95%CI:0.31-0.61;moderate certainty),bacteremia(RR:0.41,95%CI:0.30-0.56;high certainty),and sepsis(RR:0.35,95%CI:0.25-0.44;high certainty).However,probiotics did not significantly affect intra-abdominal,central line,or peritoneal infections.CONCLUSION Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.
文摘AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.
文摘BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.
文摘BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.
文摘Objective:To explore the therapeutic effect of laparoscopic radical colorectal cancer treatment in colorectal cancer patients.Methods:A total of 50 colorectal cancer patients treated between August 2018 and August 2023 were randomly divided into two groups:Group A underwent laparoscopic radical colorectal cancer surgery,while Group B received open surgery.Clinical indicators,inflammatory factors,immune function indicators,and complications were compared between the two groups.Results:Group A showed significantly shorter operation times,faster recovery times,and reduced hospital stays compared to Group B.Additionally,Group A had less abdominal drainage and intraoperative bleeding(P<0.05).Levels of interleukin(IL)-4,IL-6,ultrasensitive C-reactive protein(hs-CRP),and tumor necrosis factor-alpha(TNF-α)were lower in Group A compared to Group B(P<0.05).Furthermore,immune function indicators,including CD3+,CD4+,CD8+,and CD4+/CD8+ratios,were better in Group A(P<0.05).The complication rate in Group A was also lower than in Group B(P<0.05).Conclusion:Laparoscopic radical treatment for colorectal cancer is efficient and feasible,causing minimal immune function impairment and inflammatory response.It also shortens postoperative recovery time.
文摘AIM:To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.METHODS:We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department.Our evaluation criteria were:diagnosis of colorectal carcinoma at presurgical biopsy,elective surgery,and the same surgeon.We excluded:emergency surgery,conversions from laparotomic colectomy,and other surgeons.The endpoints we examined were:surgical time,number of lymph nodes removed,length of stay(removal of nasogastric tube,bowel movements,gas evacuation,solid and liquid feeding,hospitalization),and major complications.Seventy-two patients were divided into two groups:intracorporeal anastomosis(39 patients)and extracorporeal anastomosis(33 patients).RESULTS:Significant differences were observed between intracorporeal vs extracorporeal anastomosis,respectively,for surgical times(186.8 min vs 184.1 min,P < 0.001),time to resumption of gas evacuation(3 d vs 3.5 d,P < 0.001),days until resumption of bowel movements(3.8 d vs 4.9 d,P < 0.001),days until resumption of liquid diet(3.5 d vs 4.5 d,P < 0.001),days until resuming a solid diet(4.6 d vs 5.7 d,P < 0.001),and total hospitalization duration(7.4 d vs 8.5 d,P < 0.001).In the intracorporeal group,on average,19 positive lymph nodes were removed;in the extracorporeal group,on average,14 were removed P < 0.001).Thus,intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition,faster recovery of intestinal function,and shorter hospitalization than extracorporeal anastomosis.CONCLUSION:Short-term outcomes favor intracorporeal anastomosis,confirming that a less traumatic surgical approach improves patient outcome.
文摘AIM： To evaluate the usefulness of three-dimensional computed tomography （3DCT） in laparoscopic surgery for colorectal carcinoma. METHODS： Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group （LG）, while 56 patients underwent conventional open surgery, open group （OG）. At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery （IMA） by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery （SMA）/superior mesenteric vein （SMV）, ileocecal artery （ICA）, middle colic artery （MCA）, and inferior mesenteric vein （IMV）. We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS： The mean length of the incision in LG was 4.6254-0.89 cm, which was significantly shorter than that in OG （P〈0.001）. The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage.CONCLUSION： Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma.
文摘BACKGROUND Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer.Traditional Chinese medicine has advantages,including safety and stability,for the treatment of intestinal colic.Lamp irra-diation for abdominal ironing has been applied in the treatment of many gas-trointestinal diseases.Purple gromwell oil has the effects of clearing heat,cooling blood,reducing swelling,and relieving pain.RESULTS The general effective rate in the observation group was 95.00%,which was significantly higher than that in the control group(86.67%,P<0.05).Before treatment,there was no significant difference in the duration of symptoms between the groups(P>0.05).After 1,2,3,and 4 d of treatment,the duration of symptoms in both groups were decreased,and the duration in the observation group was significantly lower than that in the control group(96.54±9.57 vs 110.45±11.23,87.26±12.07 vs 104.44±11.68,80.45±16.21 vs 99.44±14.95,73.18±15.58 vs 92.17±14.20;P<0.05).After 1,3,5,and 7 d of treatment,the NRS scores in both groups were decreased,and the NRS scores in the observation group were significantly lower than those in the control group(3.56±0.41 vs 4.04±0.58,3.07±0.67 vs 3.74±1.02,2.52±0.76 vs 3.43±0.85,2.03±0.58 vs 3.03±0.82;P<0.05).There was no significant difference in the rate of adverse reaction occurrence between the groups(P>0.05).CONCLUSION The use of lamp irradiation combined with purple gromwell oil gauze in patients with intestinal colic after radical surgery for colorectal cancer can reduce symptom duration,alleviate intestinal colic,and improve treatment efficacy,and this approach is safe.It is worth promoting the use of this treatment in clinical practice.
