Real-life experiences and barriers to adjuvant chemotherapy in Saudi patients with advanced stage II and stage III colon cancer.

BACKGROUND: Colorectal cancer is the most common malignancy in Saudi males and third most common in females. Patients with locally advanced colon cancer may eventually develop metastatic disease if not treated promptly and according to guidelines. The recent National Comprehensive Cancer Network guideline recommends tumor resection followed by adjuvant chemotherapy for stage III and high-risk stage II tumors. Therefore, the objective of this study was to characterize patients with locally advanced colon cancer and identify factors associated with the use of adjuvant chemotherapy and the addition of oxaliplatin in locally advanced colon cancer patients. METHODS: All patients diagnosed with locally advanced colon cancer at National Guard Health Affairs (NGHA) during 2016-2021 were investigated. Patients' characteristics were compared using Chi-square and Fisher exact test, whereas predictors of adjuvant chemotherapy/Oxaliplatin use were identified using univariate and multivariate logistic regression. RESULTS: Out of 222 patients diagnosed with locally advanced colon cancer, 133 received adjuvant chemotherapy. Factors associated with adjuvant chemotherapy administration were age and smoking status. In the multivariable analysis, older patients were less likely to receive oxaliplatin than younger patients. Stage III patients diagnosed during 2019-2021 had 5.61 times higher odds of receiving oxaliplatin. CONCLUSION: The findings of this study show that older patients and smokers are less likely to be treated with adjuvant chemotherapy. Moreover, age as well as diagnosis year were important determinants of oxaliplatin administration in stage III locally advanced colon cancer patients.

Factors associated with 30-day mortality and morbidity in patients undergoing emergency colorectal surgery.

BACKGROUND: The 30-day period following emergency colorectal surgery (ECRS) is associated with high mortality and morbidity. There is a lack of data assessing factors associated with outcomes of ECRS in the Saudi population. OBJECTIVES: Assess factors associated with 30-day postoperative mortality and complications following ECRS. DESIGN: Retrospective cohort study. SETTING: Single tertiary care center, Riyadh, Saudi Arabia. PATIENTS AND METHODS: Demographic characteristics (age, sex, diagnosis, American Society of Anesthesiologists classification, pre-operative septic state, smoking, and comorbidities), operative characteristics (urgency, diverting ostomy, and procedure performed), and postoperative characteristics (length of stay, 30-day mortality, intensive care unit [ICU] admission, ICU length of stay, surgical site infection [SSI], readmission, reoperation, and complications) were collected from electronic medical records. Univariate logistic regression was used to evaluate association with the outcome measures (30-day mortality and postoperative complications). Multivariate logistic regression was applied to evaluate independent variables. MAIN OUTCOME MEASURE: Thirty-day postoperative mortality and morbidity. SAMPLE SIZE: 241 patients. RESULTS: Among 241 patients, 145 (60.2%) were men, and 80 (33.2%) patients were between 50-64 years of age. The most common indication for surgery was malignancy 138 (57%). The overall complication rate was 26.6% and the 30-day mortality rate was 11.2%. Left hemicolectomy was the most commonly performed procedure, performed in 69 (28.6%) patients. Patients between the age of 65-74 had an increased odds of death within 30 days (OR 5.25 [95% CI 1.03-26.5]) on univariate analysis. Preoperative sepsis was associated with a fourfold increase in the likelihood of 30-day mortality (OR 4.44, 95% CI 1.21-16.24, P=.024) on multivariate analysis. The likelihood of hospital re-admission increased by fivefold in patients who developed a postoperative complication (OR 5.33, 95% CI 1.30-21.78, P=.02). CONCLUSION: Preoperative sepsis was independently associated with 30-day mortality in patients undergoing ECRS, while the likelihood of hospital readmission increased in patients with postoperative complications. Expeditious control of sepsis in the emergency surgical setting by both surgical and medical interventions may reduce the likelihood of postoperative mortality. Establishing discharge protocols for postoperative ECRS patients is advocated. LIMITATIONS: Retrospective design, small sample size, and single setting.

Outcomes of emergency colorectal surgery in elderly population.

OBJECTIVES: To assess the outcomes of emergency colorectal surgeries in elderly patients over the age of 65 years. METHODS: This is a retrospective chart review study. We studied 99 patients over the age of 65 years and 142 patients younger than 65 years who underwent emergency colorectal surgery at our institute. In this study, patient demographics, operative results, length of hospital stay, and survival were analyzed. RESULTS: Emergency colorectal surgery was performed on a total of 145 men and 96 women. Patients over the age of 65 years were found to have a significantly greater proportion of pulmonary, cardiac, and endocrine comorbidities (27.3%, 84.8%, and 65.7%, respectively). The mean length of hospital stay was 26.0±32.1 days in the group of elderly patients and 17.8±22.0 days in the group of patients under the age of 65. The length of postoperative hospital stay was significantly greater in the group of elderly patients with a p-value (0.00). The length of hospital stay in the intensive care unit was 8.86±17.1 days, which was longer in the group of elderly patients, while it was 3.65±11.4 days for the group of younger patients. However, after logistic regression, the difference in the length of post-operative hospital and intensive care unit stays between elderly and non-elderly patients was not statistically significant in elderly patients. CONCLUSION: Our study suggests that the elderly population are associated with longer hospital stay and higher rates of postoperative pulmonary and cardiovascular complications compared to those under the age of 65. However, after logistic regression, age by itself was not found to be an independent risk factor for worse outcome indicating that patient comorbidities as a whole increase the risk of worse outcomes. Therefore, the care of elderly patients undergoing emergency colorectal surgery should be individualized based on several factors rather than age alone.

The role of laparoscopy in emergency colorectal surgery.

OBJECTIVES: To assess the outcomes of the laparoscopic approach compared to those of the open approach in emergency colorectal surgery. METHODS: This retrospective cohort study included all patients aged >15 years who underwent emergency colorectal surgery from 2016-2021 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients were divided based on the surgical approach into laparoscopic and open groups. RESULTS: A total of 241 patients (182 open resections, 59 laparoscopic approaches) were included in this study. The length of stay in the intensive care unit was shorter in the laparoscopic than in the open group (1±3 days vs. 7±16 days). After multivariable logistic regression, patients undergoing laparoscopic resection had a 70% lower risk of surgical site infection than those undergoing open surgery (adjusted odds ratio=0.33, 95% confidence interval: [0.06-1.67]), a difference that was not significant (p=0.18). Lastly, patients who underwent open surgery had a high proportion of 30-day mortality (n=26; 14.3%), compared to those who underwent laparoscopic resection (n=2; 3.4%, p=0.023). CONCLUSION: Laparoscopy in emergency colorectal surgery is safe and feasible, with a trend toward better outcomes. Colorectal surgery specialization is an independent predictor of an increased likelihood of undergoing laparoscopy in emergency colorectal surgery.

The 30-day hospital readmission and mortality after surgery in colorectal cancer patients.

PURPOSE: Hospital readmissions in the first weeks following surgery are common, expensive, and associated with increased mortality among colorectal cancer patients. This study is designed to assess the 30-day hospital readmission after colorectal cancer surgery and evaluate the risk factors that affect hospital readmission. METHODS: The study uses data from the Ministry of National Guard-Health Affairs Cancer Registry. All colorectal cancer patients who underwent colorectal cancer surgery between January 1, 2016, and November 31, 2021, were investigated. Factors examined were age, gender, marital status, Body Mass Index, Charlson Comorbidity Index, chemotherapy, radiotherapy, tumor stage, grade, site, surgical approach, length of stay, and discharge location. Kaplan-Meier curves were constructed to assess survival rates between readmitted and non-readmitted patients, and logistic regressions were performed to assess predictors of readmission. RESULTS: A total of 356 patients underwent tumor resection and 49 patients were readmitted within 30-day of index discharge. The most common reasons for hospital readmissions were gastrointestinal (22.45%), urinary tract infection (16.33%), and surgical site infection (12.24%). In the multivariable analysis, females were 89% more likely to be readmitted compared to males (odds ratio 1.89, 95% confidence intervals 1.00-3.58). Patients with distant metastatic tumors have higher odds of readmission (odds ratio 4.52, 95% confidence intervals 1.39-14.71) compared to patients with localized disease. CONCLUSIONS: Colorectal cancer readmission is more common in patients with metastatic disease. Strategies to reduce readmission include planned transition to outpatient care, especially among patients with a high risk of readmission.

A Large Retroperitoneal Ganglioneuroma Presenting With an Abdominal Pain: A Case Report.

Ganglioneuromas are rare benign neoplasms arising from neural crest tissue. They are a subtype of neurogenic tumors with ganglion cell origin. They are most commonly found in the retroperitoneum and posterior mediastinum. Most ganglioneuromas are found incidentally; most patients are asymptomatic, and it rarely causes symptoms, which are often induced by compression. Here we present a case of a 24-year-old lady, who was investigated for right lower abdominal pain and found to have a right retroperitoneal solid mass at the level of L5-S1, which was displacing the major vessels. The patient underwent open excision of the mass.

Constructing a question bank based on script concordance approach as a novel assessment methodology in surgical education.

BACKGROUND: Script Concordance Test (SCT) is a new assessment tool that reliably assesses clinical reasoning skills. Previous descriptions of developing SCT-question banks were merely subjective. This study addresses two gaps in the literature: 1) conducting the first phase of a multistep validation process of SCT in Plastic Surgery, and 2) providing an objective methodology to construct a question bank based on SCT. METHODS: After developing a test blueprint, 52 test items were written. Five validation questions were developed and a validation survey was established online. Seven reviewers were asked to answer this survey. They were recruited from two countries, Saudi Arabia and Canada, to improve the test's external validity. Their ratings were transformed into percentages. Analysis was performed to compare reviewers' ratings by looking at correlations, ranges, means, medians, and overall scores. RESULTS: Scores of reviewers' ratings were between 76% and 95% (mean 86% ± 5). We found poor correlations between reviewers (Pearson's: +0.38 to -0.22). Ratings of individual validation questions ranged between 0 and 4 (on a scale 1-5). Means and medians of these ranges were computed for each test item (mean: 0.8 to 2.4; median: 1 to 3). A subset of test items comprising 27 items was generated based on a set of inclusion and exclusion criteria. CONCLUSION: This study proposes an objective methodology for validation of SCT-question bank. Analysis of validation survey is done from all angles, i.e., reviewers, validation questions, and test items. Finally, a subset of test items is generated based on a set of criteria.