Aortic calcification is associated with non-infective rather than infective postoperative complications following colorectal cancer resection: an observational cohort study.

OBJECTIVES: Complications following colorectal cancer resection are common. The degree of aortic calcification (AC) on CT has been proposed as a predictor of complications, particularly anastomotic leak. This study assessed the relationship between AC and complications in patients undergoing colorectal cancer resection. METHODS: Patients from 2008 to 2016 were retrospectively identified from a prospectively maintained database. Complications were classified using the Clavien-Dindo (CD) scale. Calcification was quantified on preoperative CT by visual assessment of the number of calcified quadrants in the proximal and distal aorta. Scores were grouped into categories: none, minor (< median AC score) and major (> median AC score). The relationship between clinicopathological characteristics and complications was assessed using logistic regression. RESULTS: Of 657 patients, 52% had proximal AC (> median score (1)) and 75% had distal AC (> median score (4)). AC was more common in older patients and smokers. Higher burden of AC was associated with non-infective complications (proximal AC 28% vs 16%, p = 0.004, distal AC 26% vs 14% p = 0.001) but not infective complications (proximal AC 28% vs 29%, p = 0.821, distal AC 29% vs 23%, p = 0.240) or anastomotic leak (proximal AC 6% vs 4%, p = 0.334, distal AC 7% vs 3%, p = 0.077). Independent predictors of complications included open surgery (OR 1.99, 95%CI 1.43-2.79, p = 0.001), rectal resection (OR 1.51, 95%CI 1.07-2.12, p = 0.018) and smoking (OR 2.56, 95%CI 1.42-4.64, p = 0.002). CONCLUSIONS: These data suggest that high levels of AC are associated with non-infective complications after colorectal cancer surgery and not anastomotic leak. KEY POINTS: • Aortic calcification measured by visual quantification of the number of calcified quadrants at two aortic levels on preoperative CT is associated with clinical outcome following colorectal cancer surgery. • An increased burden of aortic calcification was associated with non-infective complications but not anastomotic leak. • Assessment of the degree of aortic calcification may help identify patients at risk of cardiorespiratory complications, improve preoperative risk stratification and assign preoperative strategies to improve fitness for surgery.

The relationship between tumour stage, systemic inflammation, body composition and survival in patients with colorectal cancer.

BACKGROUND: Disease progression in cancer is often associated with loss of weight and lean tissue and the development of a systemic inflammatory response (SIR) and these have prognostic value. The present study investigated the relationship between these factors in patients with operable colorectal cancer. METHODS: The study included 322 patients with primary operable colorectal cancer. In addition to BMI, pre-operative CT scans were used to define the presence of visceral obesity, sarcopenia and myosteatosis. Tumour and patient characteristics were recorded. Survival was analysed using univariate and multivariate Cox regression. RESULTS: There was no significant association between TNM stage and any measure of body composition. The modified Glasgow Prognostic Score (mGPS), was associated with greater BMI (p = 0.021), sarcopenia (p < 0.001), and myosteatosis (p = 0.004). On univariate analysis, there was a significant association between age (p = 0.002), ASA grade (p = 0.010), TNM stage (p < 0.001), mGPS (p = 0.001) and myosteatosis (p = 0.017) and disease specific survival. On multivariate analysis, age (HR 1.89, 95% CI 1.27-2.79, p = 0.002), TNM stage (HR 2.27, 95% CI 1.45-3.55, p < 0.001) and mGPS (HR 1.48, 95% CI 1.08-2.03, p = 0.016) remained prognostic. CONCLUSIONS: The SIR is a key hallmark of progressive nutritional and functional decline leading to poorer survival in patients with cancer.

Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: A systematic review and meta-analysis.

BACKGROUND: Appendicectomy is a well-established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery or as an open procedure. A further development in the minimally invasive appendicectomy technique has been the introduction of single incision laparoscopic surgery (SILA). AIM: To ascertain any differences in outcomes from available trials comparing SILA with conventional multi-incision laparoscopic appendicectomy (CLA). METHODS: A literature search of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL for articles from Jan1990 to June 2015 with key words: 'appendectomy', 'appendicetomy'; 'appendicitis'; 'laparoscopy'; 'keyhole'; 'single port'; 'single incision'; 'single site'; 'one port'; 'incisionless'; 'scarless'. Randomised control trials of patients with signs and symptoms of appendicitis undergoing laparoscopic appendicectomy, with one arm being SILA were included. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods. RESULTS: A total of 8 RCTs published between 2012 and 2014 with a total of 995 patients were included. Meta-analysis showed no significant differences between SILA and CLA for complication rates, post-operative ileus, length of hospital stay, return to work or post-operative pain. CLA was significantly superior to SILA with reduced operating time (mean difference 5.81 [2.01, 9.62] P = 0.003) and conversion rates (OR 4.14 [1.93, 8.91] P = 0.0003). SILA surgery had better wound cosmesis (mean difference 0.55 [0.33, 0.77] P = 0.00001). CONCLUSION: SILA is comparable to CLA in terms of complications, post-operative pain and recovery. Therefore, SILA could be a viable option in the hands of an experienced surgeons and for patients' groups who place great value on the final cosmetic outcome.