Importance Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, Setting, and Participants The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main Outcomes and Measures The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94;P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%;P  Conclusions and Relevance An increase in ERAS adherence appears to be associated with a decrease in postoperative complications.

/pdf/association-between-use-of-enhanced-recovery-after-surgery-4v0a9vzghl.pdf

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study.

MINI: In the present study, we systemically and comprehensively evaluated the prognostic significance of a combination of inflammatory factors using preoperative blood examination, and focused on the potential feasibility of our newly developed lymphocyte-CRP ratio (LCR) as a prognostic biomarker in CRC patients. We have firstly identified that a combination of lymphocytic counts along with CRP levels, which we defined as LCR, is a more reliable indicator of poor prognosis compared with other combinations of inflammatory markers, in CRC patients. Furthermore, preoperative LCR could also identify CRC patients who are at higher risk for postoperative infectious complications. Background Systemic inflammation via host-tumor interactions is currently recognized as a hallmark of cancer. The aim of this study was to evaluate the prognostic value of various combinations of inflammatory factors using preoperative blood, and to assess the clinical significance of our newly developed inflammatory score in colorectal cancer (CRC) patients. Method In total 477 CRC patients from the discovery and validation cohorts were enrolled in this study. We assessed the predictive impact for recurrence using a combination of nine inflammatory markers in the discovery set, and focused on lymphocyte-C-reactive protein ratio (LCR) to elucidate its prognostic and predictive value for peri-operative risk in both cohorts. Results A combination of lymphocytic count along with C-reactive protein levels demonstrated the highest correlation with recurrence compared with other parameters in CRC patients. Lower levels of preoperative LCR significantly correlated with undifferentiated histology, advanced T stage, presence of lymph node metastasis, distant metastasis, and advanced stage classification. Decreased preoperative LCR (using an optimal cut-off threshold of 6000) was an independent prognostic factor for both disease-free survival and overall survival, and emerged as an independent risk factor for postoperative complications and surgical-site infections in CRC patients. Finally, we assessed the clinical feasibility of LCR in an independent validation cohort, and confirmed that decreased preoperative LCR was an independent prognostic factor for both disease-free survival and overall survival, and was an independent predictor for postoperative complications and surgical-site infections in CRC patients. Conclusion Preoperative LCR is a useful marker for perioperative and postoperative management of CRC patients.

Lymphocyte-C-reactive Protein Ratio as Promising New Marker for Predicting Surgical and Oncological Outcomes in Colorectal Cancer.

Background: We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications. Methods: Articles were identified in which the specific single-use NPWT device (PICO⋄, Smith & Nephew) was compared with standard care for surgical site infection (SSI), dehiscence, or length of stay (LOS). Risk ratio (RR) ±95% confidence interval (CI) (SSI; dehiscence) or mean difference in LOS ±95% CI was calculated using RevMan v5.3. Results: There were 1863 patients (2202 incisions) represented by 16 articles. Among 10 randomized studies, there was a significant reduction in SSI rate of 51% from 9.7% to 4.8% with NPWT intervention (RR 0.49 [95% CI 0.34–0.69] p < 0.0001). There were six observational studies assessing reduction in SSI rate of 67% from 22.5% to 7.4% with NPWT (RR 0. 32 [95% CI 0.18–0.55] p < 0.0001). Combining all 16 studies, there was a significant reduction in SSI of 58% from 12.5% to 5.2% with NP...

Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications.

Background
This study examined the relationship between the magnitude of the postoperative systemic inflammatory response (SIR), the severity of complications, and long-term outcomes following surgery for colorectal cancer.

/pdf/postoperative-systemic-inflammatory-response-complication-1ecamvt9ui.pdf

Postoperative Systemic Inflammatory Response, Complication Severity, and Survival Following Surgery for Colorectal Cancer.

Introduction: Nearly 50,000 incident cancer cases are reported in Veterans Affairs (VA) Central Cancer Registry (VACCR) annually. This article provides an updated report of cancer incidence recorded in VACCR. Materials and Methods: Data were obtained from VACCR for incident cancers diagnosed in the VA health care system, focusing on 2010 data. Cancer incidence among VA patients is described by anatomical site, sex, race, stage, and geographic location, and was compared to the general U.S. cancer population. Results: In 2010, among 46,170 invasive cancers, 97% were diagnosed among men. Approximately 80% of newly diagnosed patients were white, 19% black, and less than 2% were other minority races. Median age at diagnosis was 65 years. The three most frequently diagnosed cancers among VA were prostate (29%), lung/bronchus (18%), and colon/rectum (8%). Melanoma and kidney/renal pelvis tied for fourth (4%), and urinary bladder tied for sixth with liver and intrahepatic bile duct (3.4%). Approximately ...

/pdf/cancer-incidence-among-patients-of-the-u-s-veterans-affairs-586ibe6onj.pdf

Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update

Objective:We sought to characterize the effect of postoperative complications on long-term survival after colorectal cancer (CRC) resection.Background:The impact of early morbidity on long-term survival after curative-intent CRC surgery remains controversial.Methods:The Veterans Affairs Surgical Qua

Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients.

Background: Pilot data revealed gaps in knowledge and utilization of genomic-based targeted therapy among oncologists. We report these findings, and offer a protocol for a qualitative research project aimed to elicit oncologists’ perceptions regarding use of genomic-based targeted therapy for Veterans with lung cancer at the VHA. Using the Cabana et al. theoretical framework, a model of behavior change among providers, the study will identify how oncologists’ perceptions and facility characteristics potentially affect implementation of genomic-based targeted therapy in routine care. Methods and results: We will conduct a minimum of 40 and up to 60 semi-structured interviews with oncologists to elicit perceptions of genomic-based targeted therapy in four domains: 1) knowledge; 2) attitudes; 3) intent; and 4) barriers and facilitators for practicing genomic-based targeted therapy. Conclusion: This study is the first to examine decision-making surrounding the use of genomic based targeted therapy in lung cancer management. Findings will lay the foundation to design and implement effective strategies centering on integrating genomic medicine with routine practice, and will shed light on the decision-making processes of oncologists regarding selection of genomic-based and non-genomic-based treatment plans in managing lung cancer in veterans. This research is part of a larger study that will examine the utilization, clinical effectiveness, and cost effectiveness of genomic-based therapies in the treatment of advanced lung cancer.

/pdf/genomic-based-targeted-therapy-and-management-of-advanced-hb3atto9wn.pdf

Genomic-based targeted therapy and management of advanced non-small cell lung cancer: Protocol for a qualitative study of oncologists' perceptions and behaviors regarding genomic-based targeted therapy

Guoqing J. Chen

Papers

Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients.

Genomic-based targeted therapy and management of advanced non-small cell lung cancer: Protocol for a qualitative study of oncologists' perceptions and behaviors regarding genomic-based targeted therapy