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Impact of age-related comorbidity on results of colorectal cancer surgery

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World Journal of Gastroenterology 2009年第45期15卷 5706-5711页

作者： corrado pedrazzani Guido Cerullo Giovanni De Marco Daniele Marrelli Alessandro Neri Alfonso De Stefano Enrico Pinto Franco Roviello Department of Human Pathology and Oncology Unit of Surgical OncologyUniversity of Siena 53100 SienaItaly

AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.

关键词： Colorectal cancer Elderly Post-operative complications Co-morbidity Aged

Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation: A prospective study

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World Journal of Gastroenterology 2005年第12期11卷 1872-1875页

作者： corrado pedrazzani Filippo Catalano Mara Festini Germana Zerman Anna Tomezzoli Andrea Ruzzenente Alfredo Guglielmi Giovanni de Manzoni First Department of General Surgery

AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal ***: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively ***: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo ***: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.

关键词： Barrett's esophagus Argon plasma coagulation Endoscopic treatment

Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer

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World Journal of Gastroenterology 2016年第45期22卷 9994-10001页

作者： corrado pedrazzani Guido Mantovani Gian Luca Salvagno Elisabeth Baldiotti Andrea Ruzzenente Calogero Iacono Giuseppe Lippi Alfredo Guglielmi Division of General and Hepatobiliary Surgery Department of Surgical Sciences Dentistry Gynecology and Pediatrics University of Verona Section of Clinical Biochemistry Department of Neurological Biomedical and Movement Sciences University of Verona

AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal *** This retrospective study analysed 652 patients undergoing surgery for stage Ⅰ-Ⅳ colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related *** Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients(53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL(median: 409 mg/dL; range: 143-1045 mg/d L). Preoperative fibrinogen values correlated with age(P = 0.003), completeness of tumour resection, potentially curative vs palliative(P < 0.001), presence of systemic metastasis(P < 0.001), depth of tumour invasion p T(P < 0.001), nodes involvement p N(P = 0.001) and CEA serum level(P < 0.001). The mean fibrinogen value(± SD) was 395.6 ± 120.4 mg/d L in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours(P = 0.045). The overall survival and tumourrelated survival were significantly higher in patients with fibrinogen values ≤ 400 mg/d L(P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall(P = 0.313) or tumour-related survival(P = 0.355) after controlling for other risk factors in a multivariate *** Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.

关键词： Colorectal cancer Fibrinogen Tumour markers Prognosis Colorectal surgery

Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

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World Journal of Gastrointestinal Surgery 2019年第10期11卷 395-406页

作者： corrado pedrazzani Cristian Conti Giulia Turri Enrico Lazzarini Marzia Tripepi Giovanni Scotton Matteo Rivelli Alfredo Guglielmi Division of General and Hepatobiliary Surgery Department of Surgical Sciences Dentistry Gynecology and Pediatrics University of Verona Hospital Trust

BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal *** To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal *** Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively *** groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or *** and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission *** in post-operative length of stay and adherence to ERP’s items were evaluated in the three study *** Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group ***-day overall morbidity was 32.9%whilst mortality was *** the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly *** discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.

关键词： Colorectal surgery Laparoscopic surgery Enhanced recovery protocol Age Elderly