ABSTRACT
Introducción: Los programas de cribado de cáncer colorrectal (CCR) producen riesgos, entre ellos los derivados de las cirugías colorrectales. El objetivo de este análisis es evaluar las complicaciones asociadas a la cirugía. Pacientes y métodos: Análisis retrospectivo de los pacientes que requirieron cirugía colorrectal dentro del programa poblacional de cribado de CCR de Galicia (mayo de 2013-junio de 2019). Analizamos la indicación de la cirugía y la tasa de complicaciones intrahospitalarias (levesI-II, gravesIII-V, clasificación Clavien-Dindo) y al alta. Determinamos mediante un análisis multivariante las variables asociadas a su aparición. Resultados: En el periodo analizado, 1.092 pacientes fueron intervenidos (lesión benigna 16,5%, CCR pT1 18,2%, resto CCR 64,6%), por vía laparoscópica en el 69,8% de los casos. Se detectaron complicaciones intrahospitalarias en el 19,2% de los pacientes (leves: 13,4%; graves: 5,9%; fallecimientos: 0,2%) y al alta en 159 (14,6%) pacientes. El sexo masculino se asoció a las complicaciones intrahospitalarias (OR: 2,0; IC95%: 1,3-3,0). Las variables asociadas a las complicaciones graves fueron: sexo masculino (OR: 2,6; IC95%: 1,2-5,5), hospital terciario (OR: 0,5; IC95%: 0,2-0,9) y ECOGI (OR: 0,2; IC95%: 0,05-0,6). Los factores asociados a las complicaciones tras el alta fueron edad ≥60años (OR: 1,5; IC95%: 1,0-2,3), la ubicación rectal (OR: 1,6; IC95%: 1,1-2,3) y complicaciones intrahospitalarias (OR: 2,2; IC95%: 1,5-3,2). Conclusiones: La cirugía es la principal causa de morbimortalidad asociada a un programa de cribado de CCR. Estos resultados deben ser tenidos en cuenta en la toma de decisiones en lesiones candidatas a resección endoscópica.(AU)
Introduction: Colorectal cancer (CRC) screening programs produce risks, including those derived from colorectal surgeries. The objective of this analysis is to evaluate the complications associated with the surgery. Patients and methods: Retrospective analysis including patients who required colorectal surgery within the population-based CRC screening program in Galicia (May 2013-June 2019). We analyzed the indication for surgery and the rate of in-hospital (mildI-II, severeIII-V, Clavien-Dindo classification) and at discharge complications. We performed a multivariate analysis to determine the variables independently associated. Results: In the analyzed period, 1092 patients underwent surgery (benign lesion 16.5%, pT1 CRC 18.2%, rest of CRC 64.6%) laparoscopic approach in 69.8% of the cases. In-hospital complications were detected in 19.2% of patients (mild: 13.4%; severe: 5.9%; deaths: 0.2%) and at discharge in 159 (14.6%) patients. Male sex was associated with in-hospital complications (OR: 2.0; 95%CI: 1.3-3.0). The variables associated with severe complications were: male sex (OR: 2.6; 95%CI: 1.2-5.5), tertiary hospital (OR: 0.5; 95%CI: 0.2-0.9) and ECOGI (OR: 0.2; 95%CI: 0.05-0.6). The factors associated with complications after discharge were age ≥60years (OR: 1.5; 95%CI: 1.0-2.3), rectal location (OR: 1.6; 95%CI: 1.1-2.3) and in-hospital complications (OR: 2.2; 95%CI: 1.5-3.2). Conclusions: Surgery is the main cause of morbidity and mortality associated with a CRC screening program. These results must be taken into account in the decision making of lesions that are candidates for endoscopic resection.(AU)
Subject(s)
Humans , Male , Female , Colorectal Surgery , Postoperative Complications , Incidence , Colorectal Neoplasms , Mass Screening , Multivariate Analysis , Indicators of Morbidity and Mortality , Gastroenterology , Retrospective Studies , Gastrointestinal DiseasesABSTRACT
INTRODUCTION: Colorectal cancer (CRC) screening programs produce risks, including those derived from colorectal surgeries. The objective of this analysis is to evaluate the complications associated with the surgery. PATIENTS AND METHODS: Retrospective analysis including patients who required colorectal surgery within the population-based CRC screening program in Galicia (May 2013-June 2019). We analyzed the indication for surgery and the rate of in-hospital (mildI-II, severeIII-V, Clavien-Dindo classification) and at discharge complications. We performed a multivariate analysis to determine the variables independently associated. RESULTS: In the analyzed period, 1092 patients underwent surgery (benign lesion 16.5%, pT1 CRC 18.2%, rest of CRC 64.6%) laparoscopic approach in 69.8% of the cases. In-hospital complications were detected in 19.2% of patients (mild: 13.4%; severe: 5.9%; deaths: 0.2%) and at discharge in 159 (14.6%) patients. Male sex was associated with in-hospital complications (OR: 2.0; 95%CI: 1.3-3.0). The variables associated with severe complications were: male sex (OR: 2.6; 95%CI: 1.2-5.5), tertiary hospital (OR: 0.5; 95%CI: 0.2-0.9) and ECOGI (OR: 0.2; 95%CI: 0.05-0.6). The factors associated with complications after discharge were age ≥60years (OR: 1.5; 95%CI: 1.0-2.3), rectal location (OR: 1.6; 95%CI: 1.1-2.3) and in-hospital complications (OR: 2.2; 95%CI: 1.5-3.2). CONCLUSIONS: Surgery is the main cause of morbidity and mortality associated with a CRC screening program. These results must be taken into account in the decision making of lesions that are candidates for endoscopic resection.
Subject(s)
Colorectal Neoplasms , Digestive System Surgical Procedures , Humans , Male , Middle Aged , Early Detection of Cancer , Retrospective Studies , Incidence , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiologyABSTRACT
The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370-354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3-254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39-11.18) and a Site-Morphology-Size-Access score < 9 (OR 428, 95% CI 42-4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48-13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12-26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07-20.0), vascular infiltration (OR 8.24, 95% CI 2.72-25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62-12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08-298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05-50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55-37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26-14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39-14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32-17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process.
