Surgical management of colorectal cancer in patients with psychiatric disorders
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- Hashimoto, N., Isaka, N., Ishizawa, Y. et al. Surg Today (2009) 39: 393. doi:10.1007/s00595-008-3901-9
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We analyzed the surgical data and evaluated the management of colorectal cancer (CRC) in patients with psychiatric disorders.
We reviewed the medical records of 83 patients who underwent elective surgery for CRC and divided them into a psychiatric disorder group and a control group to compare the operative data and available clinical information.
Of the 83 patients, 27 had psychiatric disorders. The most characteristic symptom of CRC was bloody stool in the psychiatric disorder group, and occult blood in the control group. Postoperative pneumonia occurred significantly more often in the psychiatric group (14.8% vs 1.8%, P = 0.019). Patients with a psychiatric disorder needed significantly more psychotropic drugs (70.4% vs 7.1%, P < 0.001), more physical restraint (44.4% vs 12.5%, P = 0.001), and exhibited more resistant behavior (51.9% vs 8.9%, P < 0.001) postoperatively than the controls. Moreover, a significant decrease in serum albumin (Alb) and total protein (TP) was seen in the psychiatric disorder group on postoperative days (PODs) 21 and 28. A psychiatric disorder was a significant predictive factor for a decrease in TP (odds ratio [OR] 24.2) and Alb (OR 8.6).
Insufficient nutrition in the psychiatric disorder group was not attributable solely to the higher incidence of postoperative complications. As psychiatric disorders compromise nutrition, integral treatment provided by surgeons and psychiatrists would improve the nutritional status of these patients and reduce the incidence of postoperative morbidity.