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Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer.

Methods

Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality.

Results

Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications.

Conclusions

Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.

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Acknowledgments

The authors thank Takeda for sponsoring the creation and maintenance of the study’s on-line database, without interfering with data collection, analysis, and conclusions of the study. *Investigators of the ANACO (Spanish study on ANAstomotic leak after COlon resection for cancer) study group: Rico MA Alvarez, Complejo Universitario de Burgos, Burgos; Brao MJ García, Complejo Hospitalario Universitario de A Coruña, A Coruña; JM Sanchez Gonzalez, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife; Mariela M. Braithwaite, Complejo Hospitalario Universitario Insular Gran Canaria, Las Palmas de Gran Canaria; E. Martı´ Martínez, Hospital Dr. Peset, Valencia; JA. Álvarez Pérez, Hospital Universitario Central de Asturias, Oviedo; A. Espí, Hospital Clínico Universitario de Valencia, Valencia; M. Trallero Anoro, Hospital Universitario y Politécnico La Fe, Valencia; M. Millán Scheiding, Hospital Universitario Bellvitge, Barcelona; O. Maseda Díaz, Hospital Universitario Lucus Augusti, Lugo; P. Dujovne Lindenbaum, Hospital Universitario Fundación Alcorcón, Alcorcón; A. Monzón Abad, Hospital Universitario Miguel Servet, Zaragoza; M. Romero Simó, Hospital General Universitario de Alicante, Alicante; J. Escoll Rufino, Hospital Universitario Arnau de Vilanova, Lleida; M. Santamaría Olabarrieta, Hospital de Cruces, Bilbao; J. Viñas Martínez, Hospital Arquitecto Marcide, Ferrol; M. Lopez Bañaeres, Hospital Arnau de Vilanova, Valencia; I. Blesa Sierra, Complejo Hospitalario Torrecárdenas, Almería; F. Feliú Villaró, Hospital Universitario Joan XXIII, Tarragona; J. Aguiló Lucía, Hospital Lluis Alcanyis, Játiva; J. Bargallo Berzosa, Hospital de Terrassa, Terrassa; N. Alonso Hernández, Hospital Universitario Son Espases, Palma de Mallorca; FJ. Labrador Vallverdú, Hospital Universitario de Guadalajara, Guadalajara; PA. Parra Baños, HGU Reina Sofía, Murcia; G. Ais Conde, Hospital General de Segovia, Segovia; R. Farres, Hospital Universitario Josep Trueta, Girona; J. Hernandis Villalba, Hospital General de Elda, Elda; C. Álvarez Laso, Hospital de Cabueñes, Gijón; S. Martínez Alcaide, Hospital de La Ribera, Alcira; MN. Cáceres Alvarado, Hospital do Meixoeiro, Vigo; I. Rey Simó, Complejo Hospitalario Universitario de A Coruña, A Coruña; J. Montero García, Hospital General de Granollers, Granollers; A. García Fadrique, Fundación Instituto Valenciano de Oncología, Valencia; V. Aguilella Diago, HCU Lozano Blesa, Zaragoza; J. García Septiem, Hospital Universitario de Getafe, Getafe; J. García García, Hospital Universitario de Salamanca, Salamanca; L. Ponchietti, Hospital de Torrevieja, Torrevieja; MS. Carceller Navarro, Hospital de Manises, Valencia; M. Ramos Fernández, Hospital Costa del Sol, Marbella; R. Conde Muiño, Hospital Universitario Virgen de las Nieves, Granada; D. Huerga Álvarez, Hospital Universitario de Fuenlabrada, Fuenlabrada; P. Menéndez Sánchez, Hospital Gutiérrez Ortega, Valdepeñas; C. Maristany Bienert, Hospital Universitario Mutua de Terrassa, Terrassa; MT. García Martínez, Complejo Hospitalario Universitario de Vigo, Vigo; C. Moreno Muzas, Hospital Obisco Polanco, Teruel; C. Pastor Idoate, Fundación Jiménez-Díaz, Madrid; A. Andicoechea, Hospital de Jove, Gijón; AP. Alonso Casado, Hospital Universitario La Princesa, Madrid; JV. Roig Vila, Consorcio Hospital General Universitario de Valencia, Valencia; I. Goded Broto, Hospital San Jorge, Huesca; P. Collera, Complejo Asistencial y Universitario de Manresa, Manresa; A. Arroyo Sebastián, Hospital General de Elche, Elche.

Funding

The authors thank Takeda for sponsoring the creation and maintenance of the study’s on-line database, without interfering with data collection, analysis and conclusions of the study.

Author information

Authors and Affiliations

  1. Department of General Surgery, Colorectal Unit, La Fe University Hospital, University of Valencia, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain

    Luis Sánchez-Guillén, Matteo Frasson, Gianluca Pellino, Blas Flor-Lorente, Álvaro García-Granero & Eduardo García-Granero

  2. Biostatistics Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain

    Victoria Fornés-Ferrer

  3. Department of General Surgery, Hospital Universitario de Getafe, Getafe, Spain

    José Luis Ramos

  4. Department of General Surgery, Hospital Torrecárdenas, Almería, Spain

    Isabel Blesa Sierra

  5. Department of General Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain

    Luis Miguel Jiménez-Gómez

  6. Center of Operations Research, Miguel Hernandez University, Elche, Alicante, Spain

    Alejandro Moya-Martínez

Authors
  1. Luis Sánchez-Guillén
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  2. Matteo Frasson
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  3. Gianluca Pellino
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  4. Victoria Fornés-Ferrer
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  5. José Luis Ramos
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  6. Blas Flor-Lorente
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  7. Álvaro García-Granero
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  8. Isabel Blesa Sierra
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  9. Luis Miguel Jiménez-Gómez
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  10. Alejandro Moya-Martínez
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  11. Eduardo García-Granero
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Consortia

Anaco Study Group

  • Rico M. A. Alvarez
  • , Brao M. J. García
  • , J. M. Sanchez Gonzalez
  • , Mariela M. Braithwaite
  • , E. Martı´ Martínez
  • , J. A. Álvarez Pérez
  • , A. Espí
  • , M. Trallero Anoro
  • , M. Millán Scheiding
  • , O. Maseda Díaz
  • , P. Dujovne Lindenbaum
  • , A. Monzón Abad
  • , M. Romero Simó
  • , J. Escoll Rufino
  • , M. Santamaría Olabarrieta
  • , J. Viñas Martínez
  • , M. Lopez Bañaeres
  • , I. Blesa Sierra
  • , F. Feliú Villaró
  • , J. Aguiló Lucía
  • , J. Bargallo Berzosa
  • , N. Alonso Hernández
  • , F. J. Labrador Vallverdú
  • , P. A. Parra Baños
  • , R. Farres
  • , J. Hernandis Villalba
  • , C. Álvarez Laso
  • , S. Martínez Alcaide
  • , M. N. Cáceres Alvarado
  • , I. Rey Simó
  • , J. Montero García
  • , A. García Fadrique
  • , V. Aguilella Diago
  • , J. García Septiem
  • , J. García García
  • , L. Ponchietti
  • , M. S. Carceller Navarro
  • , M. Ramos Fernández
  • , R. Conde Muiño
  • , D. Huerga Álvarez
  • , P. Menéndez Sánchez
  • , C. Maristany Bienert
  • , M. T. García Martínez
  • , C. Moreno Muzas
  • , C. Pastor Idoate
  • , A. Andicoechea
  • , A. P. Alonso Casado
  • , J. V. Roig Vila
  • , I. Goded Broto
  • , P. Collera
  •  & A. Arroyo Sebastián

Contributions

Data acquisition: Sánchez-Guillén, Frasson, Fornes-Ferrer, Ramos, Flor-Lorente, García-Granero, Pellino, Blesa, Jiménez. Moya, García-Granero. Drafting of manuscript: Sánchez-Guillén, Frasson. Critical revision of manuscript: García-Granero, Flor-Lorente, García-Granero.

Corresponding author

Correspondence to Matteo Frasson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The protocol was approved initially by the Ethical Committee of the Hospital Universitario de Getafe (Madrid, Spain) and then by the Ethical Committees of each participating hospital.

Consent to participate

The study was explained to the patients who met the inclusion criteria and they were asked to sign a written informed consent.

Consent for publication

All authors approved the paper.

Code availability

The statistical Package for Social Sciences (SPSS version 22.0.0; IBM SPSS statistics, IBM Corporation, Armonk, NY) was used for the descriptive and univariable analyses. The R software (version 3.4.1) was used for the logistic regression, the cross-validation of the model, and to build the nomograms (“rms” package).

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Meeting presentation: The following article was presented as Oral Presentation in the AECP meeting 2017 (Almería, May 2017), ESCP Congress 2017 (Berlin, September 2017) and AEC meeting 2017 (Malaga, October 2017).

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Sánchez-Guillén, L., Frasson, M., Pellino, G. et al. Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study. Int J Colorectal Dis 35, 2227–2238 (2020). https://doi.org/10.1007/s00384-020-03692-x

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