Associations between outcome variables of nutritional screening methods and systemic treatment tolerance in patients with colorectal cancer: A systematic review.

INTRODUCTION: Multiple screening methods for malnutrition are available, but a systematic review of evidence in patients with colorectal cancer (CRC) is lacking. The aim of this study is to systematically investigate which outcome variables of nutritional screening methods are associated with treatment tolerance in patients with CRC. MATERIAL AND METHODS: A systematic review was performed with respect to outcome variables of nutritional screening methods and their association with systemic treatment tolerance in patients with CRC. The Cochrane guidelines for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Two authors independently assessed the risk of bias and quality of each included study. RESULTS: A total of sixteen studies were included. The following screening methods for malnutrition were assessed in the included studies: serum albumin, body mass index, C-reactive protein/albumin ratio, modified version of the Glasgow prognostic score, mini nutritional assessment, nutritional risk index, patient-generated subjective global assessment, sarcopenia and weight loss. DISCUSSION: Sarcopenia tended to be associated with treatment tolerance more often than other screening methods but the current review suggests that there are ample screening methods rendering meaningful outcomes regarding a patient's nutritional status and associated risk for treatment intolerance. This grants practitioners the flexibility to choose from a variety of different nutritional screening methods. Nutritional screening can thus be tailored to the individual patient. Importantly, nutritional screening may help identify those patients at risk for chemotoxicity thus allowing for the implementation of targeted prehabilitation programs in order to prevent (severe) chemotoxicity.

Frailty screening by Geriatric-8 and 4-meter gait speed test is feasible and predicts postoperative complications in elderly colorectal cancer patients.

INTRODUCTION: Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. METHODS: This retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. RESULTS: 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. CONCLUSION: Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications.

Follow-up after surgical treatment in older patients with colorectal cancer: The evaluation of emerging health problems and quality of life after implementation of a standardized shared-care model.

INTRODUCTION: One-year mortality after hospital discharge is higher among older patients with colorectal cancer who underwent surgery compared to younger patients. Taking care of older adults with multi-morbidity is often fragmented with lack of coordination and information exchange between healthcare professionals. The aim of this study was to evaluate emerging health problems and quality of life after implementing a standardized shared-care model. MATERIAL AND METHODS: 141 patients aged ≥70 years who underwent surgery for colorectal carcinoma in two hospitals were included. A standardized transmission from hospital to primary care was set up. Patients' health status and quality of life was evaluated during subsequent follow-up moments. RESULTS: A reduction in one-year mortality rate from 10.9% to 9.2% was observed after implementation of the standardized shared-care model. Almost all health status domains improved to 'good' during follow-up moments, still the general condition remained poor in 26% of patients at week fourteen. Although quality of life improved during subsequent follow-up moments, fatigue, dyspnoea and insomnia were the most prominent persisting problems at the end of follow-up. DISCUSSION: The implementation of a standardized shared-care model for older patients after surgery for colorectal cancer resulted in a reduction in the one year mortality rate. Although most aspects of both health status and quality of life improved during subsequent follow-up moments, especially the general condition remained poor for a long time after surgery. This means that, besides a good preoperative counseling of patients, future research should focus on possible interventions to improve general condition.

Late onset pulmonary metastasis more than 10 years after primary sigmoid carcinoma.

According to current guidelines, follow-up of patients with colorectal cancer is ended after five years. Also, chest X-ray is not part of standard investigation during follow-up. We describe a case of a 74-year-old patient, more than ten years after a sigmoid resection because of carcinoma of the sigmoid. No recurrence was detected during intensive follow-up. However, ten years after resection of the sigmoid adenocarcinoma, complaints of coughing induced further examination with as result the detection of a solitary metastasis in the left lung of the patient. Within half-a-year after metastasectomy of the lung metastasis, she presented herself with thoracic pain and dyspnea resulting in discovering diffuse metastasis on pulmonary, pleural, costal and muscular level. Five year follow-up of colorectal carcinoma without chest X-ray can be questioned to be efficient. The growing knowledge of tumor biology might in future adjust the duration and frequency of diagnostic follow-up to prevent (late) recurrence in patients with colorectal carcinoma.

Postoperative drug-induced priapism.

We presented a case of a postoperative patient with low-flow priapism, possibly initiated by propofol-based anaesthesia or epidural anaesthesia. The delay in diagnosing priapism resulted in emergency interventions with a partially successful effect and eventually permanent erectile dysfunction. Due to the delay in treatment, erectile dysfunction ensued and was manageable with medication; hence, the patient decided against a penile prosthesis.

Small bowel leiomyosarcoma: a case report and literature review.

Small bowel neoplasms are very uncommon, especially leiomyosarcoma of the small bowel. Therefore, there is often a delay before small bowel leiomyosarcoma is diagnosed and treatment is started. A 60-year-old Caucasian male was admitted to our hospital with progressive melena. Gastroscopy and colonoscopy did not reveal the cause of the melena, but magnetic resonance imaging showed a jejunal tumor. After laparoscopic resection, the tumor appeared to be a grade 2 leiomyosarcoma. Small bowel neoplasms can be accurately detected by magnetic resonance enterography or wireless capsule endoscopy. Treatment almost always consists of resection of the primary tumor and its metastases. The role of chemo- and radiotherapy is not yet clear and prognosis remains very poor, with low five-year survival rates.