TITLE:
Morbidity and Mortality after Colorectal Surgery for Cancer
AUTHORS:
Giulio Paolo Angelucci, Giovanni Sinibaldi, Paolo Orsaria, Claudio Arcudi, Sergio Colizza
KEYWORDS:
Colorectal; Colorectal Surgery; Morbidity; Mortality; Surgery; Complications; Early Post-Operative Complication; Management; Anastomotic Leak; Leakage
JOURNAL NAME:
Surgical Science,
Vol.4 No.11,
November
28,
2013
ABSTRACT:
Colorectal Cancer is the second most
common cancer in western countries and, currently, surgical resection is still the principal treatment for this
pathology. However, the operation carries significant morbidity and mortality,
which is associated with an enormous use of healthcare resources. The aim of our study is to evaluate the incidence
and the management of complications, and to understand how pre-exisiting
comorbidities can influence the recovery of the patients. Between 2007 and 2012, a total of 534 patients underwent
elective or emergency surgery for colorectal cancer in our department. Patients
were identified for this study from a prospectively entered computerized
database. Case notes of patients documented comorbidities, type of surgery
performed, complication in the early postoperative period (30 days after
surgery) and the management. Postoperative morbidity affected 89 patients
(17%), of these 25 (27%) were anastomotic leakage (AL). 22 (24%) patients
experienced intra-abdominal abscess. 16 patients (17%) had wound infections. 11
patients (13%) experienced post-operative bleeding and five of them had a re-operation within the I and the II day
after surgery. 12 (13%) complained medical (cardiologic/respiratory)
complications. We had 1 (1%) Small Bowel Obstruction, treated with a
conservative therapy. Reoperation rate was 3% with 11 for AL, and 5 for
bleeding. The mortality rate was 0.55% (3 patients). In our experience, we evidenced that surgery performed for
advanced rectal cancer in the lower rectum, especially in urgency settings is
associated with an increase of morbidity and mortality in the early
post-operative period. Pre-existing comorbidities are involved in the morbidity
of the patients, and a more accurate approach both in surgical technique and in
the post-operative management can be proposed to the surgeon. Derivative stoma in high risk
patients gave us the possibility of a conservative treatment of the Anastomotic
Leak, the most common complication in our study, with antibiotics and CT-drainage.