Perioperative outcome of colorectal cancer and validation of CR-POSSUM in a Caribbean country

OBJECTIVE: To evaluate the risk-adjusted perioperative outcome of colorectal cancer surgery, applying the Colorectal Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (CR-POSSUM). METHODS: A retrospective chart review of patients who underwent colorectal cancer surgery from 2004 to 2007 was done. Data including demographics and physiological data for CR-POSSUM were recorded. Predicted mortality was calculated; validation of CR-POSSUM was done using Hosmer-Lemeshow goodness-of-fit and Receiver Operating Characteristic (ROC) Curve analyses. RESULTS: 232 patients were studied. The overall mean CR-POSSUM score was 18.3+/-3.8 (SD). Predicted mortality was 7.7%, observed mortality was 6.9% and the standardized mortality ratio was 0.9. 34.4% of patients presented with Duke's Stage C or D and had a higher risk of mortality (Odds Ratio (OR) 3.1, 95% Confidence Intervals (CI) 1.1, 9.1). Emergency surgery was associated with a higher risk of mortality (OR 4.7, 95% CI 1.5, 14.1). CR-POSSUM calibrated well (Hosmer-Lemeshow Chi-square value 4.3; df: 8; p=0.82) and fairly discriminated outcome as shown by the area under the ROC Curve 0.69, (Standard Error: 0.07). CONCLUSIONS: Perioperative outcome of colorectal surgery in Trinidad and Tobago is comparable to the developed countries as evaluated by the CR-POSSUM. Patients presenting for emergency surgery and those with advanced stages of cancer had higher perioperative mortality.

Colorectal cancer in Jamaica - Poster abstract

OBJECTIVE: This review was designed as a pilot study to collect data on colorectal cancer surgery which would provide the basis for conducting formal prospective data collection on the patterns of this disease and its clinical presentation. DESIGN AND METHOD: A comprehensive audit of all patients with a diagnosis of colorectal carcinoma was undertaken over a 2 year period (January 1996 to December 1997). RESULTS: A total of seventy-nine patients were studied. There were 47 females and 32 males. The median age was 64.5 years (range 19 to 91 years). The predominant presenting symptoms were abdominal pain in 44 patients (55.7 percent), change in bowel habit in 38 patients (48.1 percent) and rectal bleeding in 37 patients (46.8 percent). The presence of an abdominal mass in 18 patients was the most frequently detected sign. Rectal examination detected the presence of a mass in 14 (17.7 percent) patients. Forty-seven percent of patients present with anaemia. The most common location was the right colon in 21 patients (26.5 percent) followed by sigmoid colon in 15 (18.9 percent) and rectum in 14 (17.7 percent). Left and transverse colon accounted for 7 and 5 cases, respectively. Resection with restorative anastomosis was the most common procedure for primary disease with colostomy being performed infrequently (in 3 cases). Seventeen patients presented with advanced disease. There were 14 deaths, 10 due to metastatic disease and 4 from postoperative complications. Our findings indicate an increased incidence of right-sided colonic carcinomas which has also been reported by other recent series. Although this colorectal audit provides some information about the patterns of disease seen in our unit, further study of a larger group of patients will be necessary before accurate conclusion can be made. CONCLUSION: The detection of early colorectal carcinoma will require screening at a stage when the disease is asymptomatic in order to improve the chance for cure. The data presented here indicate that the majority of patients presented with advanced right sided lesions that could have been detected earlier with an established screening programme.(AU)

Colorectal cancer screening: sigmoidoscopic findings in 651 aymptomatic individuals - abstract

Ninety-six per cent of asymptomatic subjects > 50 years of age who attended an Executive Medical Programme at the Eric Williams Medical Sciences Complex, Trinidad, agreed to have sigmoidoscopy performed as did 57 subjects < 50 years of age. A total of 651 individuals of an asymptomatic West Indian population comprised the study group. There were 461 males and 190 females and 594 were > 50 years of age; 84 patients had single biopsies and 28 had multiple biopsies. Two carcinoid tumours and 74 polyps were found of which 18 were pre-malignant lesions (1 villous, 5 tubulo-billous, and 12 tubular adenomas). The likelihood of biopsies being performed above the age of 70 years was over 50 percent and the chance of there being a pre-malignant lesion was 35 percent. Data from this preliminary study suggest that distal colorectal pathology in our asymptomatic population parallels that of developed countries. This may be an indication that colorectal cancer is far more prevalent in Trinidad than is at present documented (AU)

Colorectal carcinoma in Trinidad - abstract

Colorectal cancer is the fifth commonest cause of death from malignancies in Trinidad. Data available from the Ministry of Health and the Central Statistical Office in the 10-year period 1969-1978 provided 620 cases for analysis. In addition, 152 confirmed cases from the Port-of-Spain General Hospital were reviewed. The mortality rate for cancer of the colon was 4.4 per 100,000 of population with an increasing trend over the 10-year period. The mortality rate for rectal cancer was 1.8 per 100,000 of population with a decreasing trend. The average age of diagnosis was 64.3 years with rapidly rising incidence with advancing age. The M: F ratios are 1 : 1.05 and 1.1 : 1 for cancer of the colon and rectum respectively. There was a higher incidence in the Black, Chinese and Christian communities and a lower incidence in the East Indian, Hindu and Muslim communities. The Chinese had lesions predominantly on the left and the East Indians on the right side of the colon and in the rectum. The negroes had a more even distribution of the lesions. Only 51.6 percent of the lesions were in the rectum and sigmoid colon and 7.4 percent of the cancers were multiple. A relatively high percentage of Stage IV cases (39 percent) was encountered, with a correspondingly low resectability rate (67 percent) and high incidence of intestinal obstruction (29.9 percent). Fortunately, in the later years of the study, more early cancers and less Stage IV lesions had been diagnosed. The increasing incidence of colon cancer demands that a higher index of suspicion with more liberal use of barium enema and sigmoidoscopic examinations be employed in order to make earlier diagnosis and deliver prompt treatment (AU)

Oral contraceptives: beyond pregnancy prevention, Part 1

Combined oral contraceptives (COC) have become an integral part of birth control. A growing body of knowledge is pointing to several non contraceptive benefits of COCs while illuminating the potential risks of the "pills". Pharmacists have a critical role to play in promoting the safe and effective use of these medications