KOLOREKTAL KANSER NEDENİYLE AMELİYAT GİREN HASTALARIN AMELİYAT ÖNCESİ BAĞIRSAK HAZIRLIK MODELLERİNİN KARŞILAŞTIRILMASI
Abstract
Amaç
Toplumda en sık görülen kanser kolorektal kanserdir (KRK). Cerrahi morbidite ve mortaliteyi azaltmayı amaçlayan çalışmalar, preoperatif barsak hazırlığının önemli bir katkısını bulmuştur. Bağırsak hazırlığı için modeller arasında mekanik temizlik, antibiyotik kullanımı ve kontrol grupları yer alıyordu. Bu çalışmada elektif kolorektal kanser için preoperatif barsak hazırlığını karşılaştırdık ve etkilerini değerlendirdik.
Materyal ve metodlar
Kolorektal kanserli 144 hastayı (n=144) prospektif olarak dört gruba ayırmak için preoperatif barsak hazırlama modeli kullanıldı. Birinci gruptaki hastalara (Grup I) mekanik barsak hazırlığı (MBH), ikinci gruba (Grup II) oral antibiyotik tedavisi (OAB) ve MBH, üçüncü gruba intravenöz antibiyotik tedavisi (IVAB), MBH ve OAB uygulandı. grup (Grup III) ve dördüncü grupta (Grup IV) barsak hazırlığı yapılmadı. Hastalar arasında demografik bilgiler, anastomoz kaçağı, cerrahi alan enfeksiyonu, karın içi apse, postoperatif ileus ve ölüm karşılaştırıldı.
Bulgular
Çalışmanın Grup I, II, III ve IV'ünde sırasıyla 35 hasta, 38 hasta, 35 hasta ve 36 hasta vardı. Gruplar yaş, cinsiyet ve ASA (American Society of Anesthesiologists) puanına göre değerlendirildiğinde dört grup arasında istatistiksel olarak anlamlı fark yoktu (p> 0,05). Cerrahi alan enfeksiyonu (CAE), intraabdominal apse ve anastomoz kaçağı arasında anlamlı fark vardı (p0.05). Mortalite ve postoperatif ileus arasında anlamlı fark yoktu (p > 0.05).
Sonuç
Elektif KRK nedeniyle ameliyat olmuş hastalarda mekanik kolon temizliği ve antibiyotik uygulamalarının barsak hazırlığı yaklaşımının uygun olduğunu düşünüyoruz.
Keywords
References
- 1. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006; 202: pp. 439-444.
- 2. Hunt TK, Hawley PR. Surgical judgement and colonic anastomoses. Dis Colon Rectum 1969; 12:167-71.
- 3. Cannon JA, Altom LK, Deierhoi RJ, et al. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Dis Colon Rectum 2012;55(11):1160–1166.
- 4. Nichols RL , Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet 1971;132:323–337.
- 5. Biondo S, Jaurrieta E, Jorba R, et al. Intra-operative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 1997; 84: pp. 222-225.
- 6. Ambe P.C. , Zarras K. , Stodolski M. , Wirjawan, I. , Zirngibl H. Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer. World J of Surg Oncol. 2019;17(1): 20.
- 7. Murray AC , Kiran RP. Bowel Preparation: Are Antibiotics Necessary for Colorectal Surgery? Adv Surg. 2016 Sep;50(1):49-66.
- 8. Gönen Ö. Kolorektal kanser epidemiyolojisi. Kolorektal Özel Sayısı. Türkiye Klinikleri J of Surg 2004;9:11-14.
- 9. Eddy DM. Screening for colorectal cancer. Ann Intern Med. 1990; 113:373.
- 10. Hammond J, Lim S, Wan Y, Gao X, Patkar A. The burden of gastrointestinal anastomotic leaks: An evaluation of clinical and economic outcomes. J Gastrointest Surg 2014;18:1176–1185.
- 11. Nichols RL, Condon RE, Gorbach SL, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972;176:227–232.
- 12. Fry DE. Colon preparation and surgical site infection. Am J Surg. 2011;202:225–232.
- 13. Slim K, Vicaut E, Launau-Savary MV, Contant C, Chipponi C. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–209.
- 14. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection. Ann Surg 2015;262:331–337.
- 15. Midura EF, Jung AD, Hanseman DJ, et al. Combination oral and mechanical bowel preparations decreases complications in both right and left colectomy. Surgery. 2018;163:528-534.
- 16. McSorley ST, Steele CW, McMahon AJ. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgicalsite infections in elective colorectal surgery. BJS Open. 2018;2:185-194.
- 17. Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013; 148: 65–71.
- 18. Hata H, Yamaguchi T, Hasegawa S, Nomura A, et al. Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07-01): a phase 3, multicenter, open-label, randomized trial. Ann Surg 2016; 263: 1085–1091.
- 19. Garfinkle R, Abou-Khalil J, Morin N, et al. Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum 2017; 60: 729–737.
- 20. Nichols RL, Smith JW, Garcia RY, Waterman RS, Holmes JW. Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis Off Publ Infect Dis Soc Am 1997:24(4):609–619.
- 21. Gillespie G, McNaught W. Prohylactic oral metronidazole in intestinal surgery. J Antimicrob Chemother 1978:4 Suppl C:29–32.
- 22. Toh JWT, Phan K, Hitos K, et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta‐analysis. JAMA Netw Open 2018; 1: e183226.
- 23. Koller SE, Bauer KW, Egleston BL, et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 2018; 267: 734–732.
- 24. Kaslow SR, Gani F, Alshaikh HN, Canner JK. Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery. BJS open. 2018;2(4):238–245.
- 25. Kim EK, Sheetz KH, Bonn J, et al. A statewide colectomy experience: The role of full bowel preparation in preventing surgical site infection. Ann. Surg. 2014;259:310–314.
COMPARISON OF PREOPERATIVE BOWEL PREPARATION MODELS OF PATIENTS WHO UNDERWENT SURGERY FOR COLORECTAL CANCER
Abstract
Background
The most prevalent cancer in society is colorectal cancer (CRC). Studies aiming to lower surgical morbidity and mortality have found a significant contribution from preoperative bowel preparation. Models for bowel preparation included mechanical cleaning, the use of antibiotics, and control groups. We compared preoperative bowel preparation for elective colorectal cancer and evaluated its effects in this study.
Material and Methods
Preoperative bowel preparation model was used to prospectively split 144 patients (n=144) with colorectal cancer into four groups. Patients in the first group (Group I) underwent mechanical bowel preparation (MBP), followed by oral antibiotic therapy (OAB) and MBP in the second group (Group II), intravenous antibiotic therapy (IVAB), MBP, and OAB in the third group (Group III), and no bowel preparation in the fourth group (Group IV). Demographic information, anastomotic leakage, surgical site infection, intraabdominal abscess, postoperative ileus, and death were compared between patients.
Results
Groups I, II, III, and IV of the study each had 35 patients, 38 patients, 35 patients, and 36 patients, respectively. There was no statistically significant difference between the four groups when the groups were evaluated by age, gender, and ASA (American Society of Anesthesiologists) score (p> 0.05). There were significant differences between surgical site infection (SSI), intraabdominal abscess, and anastomosis leaking (p0.05). Mortality and postoperative ileus did not differ significantly (p > 0.05).
Conclusion
We consider that the bowel preparation approach of mechanical colon cleansing and antibiotic administration is appropriate for patients who have had surgery owing to elective CRC.
Keywords
References
- 1. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006; 202: pp. 439-444.
- 2. Hunt TK, Hawley PR. Surgical judgement and colonic anastomoses. Dis Colon Rectum 1969; 12:167-71.
- 3. Cannon JA, Altom LK, Deierhoi RJ, et al. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Dis Colon Rectum 2012;55(11):1160–1166.
- 4. Nichols RL , Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet 1971;132:323–337.
- 5. Biondo S, Jaurrieta E, Jorba R, et al. Intra-operative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 1997; 84: pp. 222-225.
- 6. Ambe P.C. , Zarras K. , Stodolski M. , Wirjawan, I. , Zirngibl H. Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer. World J of Surg Oncol. 2019;17(1): 20.
- 7. Murray AC , Kiran RP. Bowel Preparation: Are Antibiotics Necessary for Colorectal Surgery? Adv Surg. 2016 Sep;50(1):49-66.
- 8. Gönen Ö. Kolorektal kanser epidemiyolojisi. Kolorektal Özel Sayısı. Türkiye Klinikleri J of Surg 2004;9:11-14.
- 9. Eddy DM. Screening for colorectal cancer. Ann Intern Med. 1990; 113:373.
- 10. Hammond J, Lim S, Wan Y, Gao X, Patkar A. The burden of gastrointestinal anastomotic leaks: An evaluation of clinical and economic outcomes. J Gastrointest Surg 2014;18:1176–1185.
- 11. Nichols RL, Condon RE, Gorbach SL, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972;176:227–232.
- 12. Fry DE. Colon preparation and surgical site infection. Am J Surg. 2011;202:225–232.
- 13. Slim K, Vicaut E, Launau-Savary MV, Contant C, Chipponi C. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–209.
- 14. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection. Ann Surg 2015;262:331–337.
- 15. Midura EF, Jung AD, Hanseman DJ, et al. Combination oral and mechanical bowel preparations decreases complications in both right and left colectomy. Surgery. 2018;163:528-534.
- 16. McSorley ST, Steele CW, McMahon AJ. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgicalsite infections in elective colorectal surgery. BJS Open. 2018;2:185-194.
- 17. Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013; 148: 65–71.
- 18. Hata H, Yamaguchi T, Hasegawa S, Nomura A, et al. Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07-01): a phase 3, multicenter, open-label, randomized trial. Ann Surg 2016; 263: 1085–1091.
- 19. Garfinkle R, Abou-Khalil J, Morin N, et al. Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum 2017; 60: 729–737.
- 20. Nichols RL, Smith JW, Garcia RY, Waterman RS, Holmes JW. Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis Off Publ Infect Dis Soc Am 1997:24(4):609–619.
- 21. Gillespie G, McNaught W. Prohylactic oral metronidazole in intestinal surgery. J Antimicrob Chemother 1978:4 Suppl C:29–32.
- 22. Toh JWT, Phan K, Hitos K, et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta‐analysis. JAMA Netw Open 2018; 1: e183226.
- 23. Koller SE, Bauer KW, Egleston BL, et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 2018; 267: 734–732.
- 24. Kaslow SR, Gani F, Alshaikh HN, Canner JK. Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery. BJS open. 2018;2(4):238–245.
- 25. Kim EK, Sheetz KH, Bonn J, et al. A statewide colectomy experience: The role of full bowel preparation in preventing surgical site infection. Ann. Surg. 2014;259:310–314.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 23, 2023 |
| Published in Issue | Year 2023 Volume: 14 Issue: 1 |
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e-ISSN: 2149-8296
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