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首页> 外文期刊>Acta oncologica. >Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation
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Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation

机译：结肠直肠外科的术前可改性危险因素：一个观察队列研究，了解初期可能的价值

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Background: Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the most common therapeutic intervention, and associated with 20-40% reduction in physiological and functional capacity. Postoperative complications occur in up to 50% of patients resulting in higher mortality rates and greater hospital costs. The number and severity of complications is closely related to patients' preoperative performance status. The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program.Methods: Prospectively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed. Modifiable risk factors were correlated to the Comprehensive Complication Index (CCI) and compared within two groups: none or mild complications (CCI 20), and severe complications (CCI 20). Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors.Results: In this 139 patient cohort, smoking, malnutrition, alcohol consumption, neoadjuvant therapy, higher age, and male sex, were seen more frequently in the severe complications group (CCI 20). Patients with severe complications had significantly longer hospital stay (16 vs. 6 days, p0.001). The risk for severe complications was increased in patients with ASA score III [adjusted odds ratio (OR) 4.4, 95% CI 1.04-18.6], and hemoglobin level 7mmol/l (adjusted OR 3.3, 95% CI 1.3-8.2). Compared to having no risk factors, more than one risk factor increased OR of severe complications (crude OR 5.2, 95% CI 1.8-15).Conclusion: This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively. Several preoperative patient-related risk factors are modifiable. Multimodal prehabilitation may improve patients' preoperative status and should be tested in a multicenter randomized controlled trial. With an international consortium (Copenhagen, Montreal, Paris, Eindhoven) we initiated a randomized controlled trial (NTR5947).
机译：背景：结肠直肠癌（CRC）是世界上最普遍的癌症类型。手术是最常见的治疗干预，并与生理和功能能力降低20-40％。术后并发症患者的50％患者发生，导致死亡率更高，医院成本更高。并发症的数量和严重程度与患者的术前表现状态密切相关。本研究的目的是识别可能成为多式化术前计划的一部分的最重要的术前可修改的危险因素。方法：分析了经过结直肠手术的连续系列患者的前瞻性收集的数据。可改变的风险因素与综合并发症指数（CCI）相关，并在两组内进行比较：无或轻度并发症（CCI＆ 20）和严重的并发症（CCI 20）。进行多元逻辑回归分析以探讨个体风险因素的综合效果。结果：在严重的并发症集团中，在严重的并发症组中更频繁地看到了这139名患者队列，吸烟，营养不良，酒精消费，新辅助治疗，更高的年龄和男性性别（CCI 20）。严重并发症的患者显着长时间的住院住院（16次，P <0.001）。 ASA得分III的患者[调整后的大量比率（或）4.4,95％CI 1.04-18.6]和血红蛋白水平＆ 7mmol / L（调节或3.3,95％CI 1.3-8.2）中，严重并发症的风险增加。与没有危险因素相比，不止一个危险因素增加或严重并发症（原油或5.2,95％CI 1.8-15）。结论：本研究表明，患有严重并发症的风险随着风险因素的数量增加而增加术前。有几种术前患者相关的危险因素是可修改的。多式联运效率可能改善患者的术前状态，并应在多中心随机对照试验中进行测试。通过国际财团（哥本哈根，蒙特利尔，巴黎，埃因霍温），我们启动了一个随机对照试验（NTR5947）。

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