Post-operative complications after colorectal cancer surgery increased with higher BMI.

INTRODUCTION: Because of conflicting evidence regarding overweight and post-operative complications, this study focused on post-operative complications and death within 30 and 90 days after curatively intended surgery for colorectal cancer and its association with BMI. METHODS: The study included all patients who had potentially curative surgery for colon or rectum cancer in Denmark from 2014 through 2018. The primary endpoint was post-operative complications within 30 days of surgery and secondary endpoints were 30- and 90-day mortality. All clinically relevant confounders were included in a multivariate analysis. RESULTS: The cohort included 14,004 patients. In the multivariate logistic regression analysis, adjusting for relevant confounders, we found the odds ratio of having a surgical complication or having both a surgical and medical complication at the same time to be rising with increasing weight class. The multivariate analysis showed the odds ratio for both 30- and 90-day mortality to be higher for underweight patients and for obesity class III patients, but the rest of the patients had no significant differences in relative risk compared with normal-weight patients. CONCLUSION: Based on our results, the risk of post-operative complications rises with increasing weight, whereas post-operative morbidity is increased only in the underweight and morbidly obese patients. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (REG-008-2020).

Anastomotic technique is not associated with leakage rate after right hemicolectomy.

INTRODUCTION: The present study aimed to evaluate the anastomotic leakage rate in relation to anastomotic technique in right hemicolectomy in a single high-volume centre. METHODS: This was a retrospective single-centre study of prospectively collected data of patients undergoing right hemicolectomy or ileocecal resection in an acute or elective setting over a seven-year period in a large University Hospital. Anastomotic leakage, anastomotic technique (hand-sewn versus stapled anastomosis) and potential confounders were registered. The possible confounding risk factors were explored by univariate analysis. Any variables with a p value less-than 0.2 after univariate logistic regression analysis were included in a subsequent multivariate logistic regression analysis. RESULTS: A total of 754 patients had a primary anastomosis performed. In 222 (29%) of the patients, anastomosis was hand-sewn and in 528 (70%) stapled. Overall, 26 patients (3.4%) developed an anastomotic leakage. The anastomotic leakage rate was similar following hand-sewn and stapled anastomoses (3.6% (8/221) versus 3.4% (18/527); p = 0.89). Univariate analyses failed to identify any significant risk factors for anastomotic leakage. A multivariate logistic regression analysis with all mentioned co-variates was performed. None of the included variables were significantly associated with anastomotic leakage. CONCLUSIONS: In the present study, we found no significant difference between hand-sewn versus stapled anastomosis. FUNDING: none. TRIAL REGISTRATION: not relevant.

Post-operative recovery is not a limiting factor for adjuvant chemotherapy in patients undergoing surgery for colorectal cancer.

INTRODUCTION: Little is known about factors affecting the initiation of adjuvant chemotherapy (AC) after minimally invasive surgery. The aim of this study was to describe the ratio of patients undergoing uncomplicated colorectal cancer surgery in a standardised enhanced recovery after surgery setting receiving AC. Furthermore, the association between post-operative quality of recovery and initiation of AC was investigated. METHODS: This was a prospective study. Post-operative recovery was measured with the Quality of Recovery-15 questionnaire preoperatively, post-operatively on day 1, at discharge and on post-operative day 30. RESULTS: A total of 115 patients were included between October 2016 and May 2017. Among these, 20 patients were excluded. Hence, 95 patients were followed up as uncomplicated cases. The median length of stay was three days (interquartile range: 2-4). A total of 40 patients were referred for oncological evaluation, but nine patients did not proceed to receive AC. Among the 31 patients starting AC, 48% (n = 15) received AC less-than 4 weeks and 52% (n = 16) > 4 weeks. No significant difference was seen in post-operative quality of recovery, either when investigating the full cohort or subgroups of patients who initiated AC before and after four weeks. CONCLUSIONS: Post-operative recovery may not be the factor limiting patients from receiving adjuvant chemotherapy either before or after post-operative week four. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Data Protection Agency (reg. no. REG044-2018).