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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)
Updates in Surgery, Volume 75, No. 6, Year 2023
Notification
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Description
Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderate: ASA 1–14 (1.9%); ASA 2–202 (26.8%); ASA 3–341 (45.3%); ASA 4–84 (11.2%); ASA 5–7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2–16 patients (18.6%); ASA 3–41 patients (47.7%); ASA 4–19 patients (22.1%); ASA 5–3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild–moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild–moderate and severe groups. Long-term survival data: in mild–moderate disease-free survival (median, IQR) is 28 (10–91) and in severe IC, it is 21 (10–94). Overall survival (median, IQR) is 44 (18–99) and 26 (20–90) in mild–moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16–81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild–moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients. © 2023, The Author(s).
Authors & Co-Authors
Coccolini, Federico
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Cremonini, Camilla
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Cobuccio, Luigi
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Strambi, Silvia
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Miccoli, Mario
Italy, Pisa
Università Di Pisa
Salvetti, Francesco
Unknown Affiliation
Fugazzola, Paola
Unknown Affiliation
Ceresoli, Marco
Unknown Affiliation
Litvin, A. A.
Unknown Affiliation
Lostoridis, Eftychios
Unknown Affiliation
Ahmed, Ali Yasen Mohamed
Unknown Affiliation
Manatakis, Dimitrios K.
Unknown Affiliation
Negoi, Ionut
Unknown Affiliation
Ioannidis, Orestis M.
Unknown Affiliation
Uzunoglu, Mustafa Yener
Unknown Affiliation
Tochie, Joel Noutakdie
Unknown Affiliation
Cillara, Nicola
Unknown Affiliation
Tomadze, Gia
Unknown Affiliation
Bala, Miklosh
Unknown Affiliation
Isik, Arda A.
Unknown Affiliation
Fonseca, Vinicius Cordeiro
Unknown Affiliation
Bellanova, Giovanni
Unknown Affiliation
Ghnnam, Wagih Mommtaz
Unknown Affiliation
Altintoprak, Fatih
Unknown Affiliation
Chirica, Mircéa
Unknown Affiliation
Zese, Monica
Unknown Affiliation
Balalis, Dimitrios
Unknown Affiliation
Cui, Yunfeng
Unknown Affiliation
Luppi, Davide
Unknown Affiliation
Yovtchev, Yovcho P.
Unknown Affiliation
Nikolopoulos, Ioannis
Unknown Affiliation
Costa, Gianluca
Unknown Affiliation
Occhionorelli, Savino
Unknown Affiliation
Nardi, Matteo
Unknown Affiliation
Gubbiotti, Francesca
Unknown Affiliation
Catena, Fausto
Unknown Affiliation
Scaramuzzo, Rosa
Unknown Affiliation
Zakaria, Andee Dzulkarnaen
Unknown Affiliation
Seretis, Charalampos
Unknown Affiliation
Gelmini, Roberta
Unknown Affiliation
Pappalardo, Vincenzo
Unknown Affiliation
Sydorchuk, R.
Unknown Affiliation
Mulita, Francesk
Unknown Affiliation
Elbahnasawy, Mohamed
Unknown Affiliation
Sibilla, Maria Grazia
Unknown Affiliation
Zaghi, Claudia
Unknown Affiliation
Podda, Mauro Guido
Unknown Affiliation
Osipov, Aleksei V.
Unknown Affiliation
Brisinda, Giuseppe
Unknown Affiliation
Akhmeteli, Lali
Unknown Affiliation
Lončar, Zlatibor
Unknown Affiliation
Garzali, Ibrahım Umar
Unknown Affiliation
Dimitrov, Evgeni Nikolaev
Unknown Affiliation
Chowdhury, Sharfuddin M.E.K.
Unknown Affiliation
Patel, Tapan J.
Unknown Affiliation
Sartelli, Massimo
Unknown Affiliation
Tartaglia, Dario
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Chiarugi, Massimo
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Statistics
Authors: 58
Affiliations: 2
Identifiers
Doi:
10.1007/s13304-023-01521-8
ISSN:
2038131X
Research Areas
Cancer
Food Security
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study