Browsing by Subject "Colorectal"

Now showing 1 - 3 of 3
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    A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database
    (Elsevier, 2023-06-03) Duggan, Ben S.; Becker, Tim; DeLeon, Genaro A.; Rao, Varun; Pei, Kevin Y.; Medicine, School of Medicine
    Introduction: Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis. Methods: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression. Results: 7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, p=<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, p<0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, p = 0.2). Postoperative length of stay (7 vs 12 days, p=<0.001), septic shock (6.7% vs 27%, p=<0.001), and organ space SSI (3.2% vs 6.9%, p=<0.001) were significantly decreased using a laparoscopic approach. Discussion: 30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors. Conclusion: Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.
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    Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis
    (BMC, 2022-09-12) Alhumaid, Saad; Al Mutair, Abbas; Busubaih, Jawad S.; Al Dossary, Nourah; Alsuliman, Murtadha; Baltyour, Sarah A.; Alissa, Ibrahim; Al Hassar, Hassan I.; Al Aithan, Noor A.; Albassri, Hani A.; AlOmran, Suliman A.; ALGhazal, Raed M.; Busbaih, Ahmed; Alsalem, Nasser A.; Alagnam, Waseem; Alyousef, Mohammed Y.; Alseffay, Abdulaziz U.; Al Aish, Hussain A.; Aldiaram, Ali; Al Eissa, Hisham A.; Alhumaid, Murtadha A.; Bukhamseen, Ali N.; Al Mutared, Koblan M.; Aljwisim, Abdullah H.; Twibah, Abdullah M.; AlSaeed, Meteab M.; Alkhalaf, Hussien A.; ALShakhs, Fatemah M.; Koritala, Thoyaja; Al-Tawfiq, Jaffar A.; Dhama, Kuldeep; Rabaan, Ali A.; Al-Omari, Awad; Medicine, School of Medicine
    Background: Patients with colorectal cancer (CRC) are more likely to develop severe course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and experience increased risk of mortality compared to SARS-CoV-2 patients without CRC. Objectives: To estimate the prevalence of SARS-CoV-2 infection in CRC patients and analyse the demographic parameters, clinical characteristics and treatment outcomes in CRC patients with COVID-19 illness. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature for studies on the incidence of SARS-CoV-2 infection in CRC patients, published from December 1, 2019 to December 31, 2021, with English language restriction. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). Sub-group analyses were performed to minimize heterogeneity. Binary logistic regression model was used to explore the effect of various demographic and clinical characteristics on patient's final treatment outcome (survival or death). Results: Of the 472 papers that were identified, 69 articles were included in the systematic review and meta-analysis (41 cohort, 16 case-report, 9 case-series, 2 cross-sectional, and 1 case-control studies). Studies involving 3362 CRC patients with confirmed SARS-CoV-2 (all patients were adults) were analyzed. The overall pooled proportions of CRC patients who had laboratory-confirmed community-acquired and hospital-acquired SARS-CoV-2 infections were 8.1% (95% CI 6.1 to 10.1, n = 1308, 24 studies, I2 98%, p = 0.66), and 1.5% (95% CI 1.1 to 1.9, n = 472, 27 studies, I2 94%, p < 0.01). The median patient age ranged from 51.6 years to 80 years across studies. The majority of the patients were male (n = 2243, 66.7%) and belonged to White (Caucasian) (n = 262, 7.8%), Hispanic (n = 156, 4.6%) and Asian (n = 153, 4.4%) ethnicity. The main source of SARS-CoV-2 infection in CRC patients was community-acquired (n = 2882, 85.7%; p = 0.014). Most of those SARS-CoV-2 patients had stage III CRC (n = 725, 21.6%; p = 0.036) and were treated mainly with surgical resections (n = 304, 9%) and chemotherapies (n = 187, 5.6%), p = 0.008. The odd ratios of death were significantly high in patients with old age (≥ 60 years) (OR 1.96, 95% CI 0.94-0.96; p < 0.001), male gender (OR 1.44, 95% CI 0.41-0.47; p < 0.001) CRC stage III (OR 1.54, 95% CI 0.02-1.05; p = 0.041), CRC stage IV (OR 1.69, 95% CI 0.17-1.2; p = 0.009), recent active treatment with chemotherapies (OR 1.35, 95% CI 0.5-0.66; p = 0.023) or surgical resections (OR 1.4, 95% CI 0.8-0.73; p = 0.016) and admission to ICU (OR 1.88, 95% CI 0.85-1.12; p < 0.001) compared to those who survived. Conclusion: SARS-CoV-2 infection in CRC patient is not uncommon and results in a mortality rate of 26.2%. Key determinants that lead to increased mortality in CRC patients infected with COVID-19 include older age (≥ 60 years old); male gender; Asian and Hispanic ethnicity; if SARS-CoV-2 was acquired from hospital source; advanced CRC (stage III and IV); if patient received chemotherapies or surgical treatment; and if patient was admitted to ICU, ventilated or experienced ARDS.
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    Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study
    (JMIR, 2022-08-11) Vachon, Eric; Robb, Bruce W.; Haggstrom, David A.; School of Nursing
    Background: There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. Objective: The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. Methods: A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. Results: The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. Conclusions: This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.