Perioperative cardiovascular and noncardiovascular risk in patients with colorectal cancer

Abstract

Background: The success of operation for colorectal cancer (CC) depends also on a good stratification of perioperative risk.
Objective: To evaluate the prognostic significance of perioperative risk in patients with CC a comparison of two groups of patients – surviving and non-surviving – was done. We compare cardiovascular and noncardiovascular risk factors, disease and complications in these two groups.
Patients: 60 patients (m:30, f:30), average age: 73 ys, surviving (38), non-surviving (22)
Methods: We are comparing following parameters: risk factors (Arterial Hypertension,diabetes mellitus,hyperlipoproteinemia,the smoking or alcohol,malnourished,obesity), cardiovascular diseases (coronary artery disease,heart failure,prior brain stroke,revascularisation,chronical venosus insuficiency), noncardiovascular diseases (COPD,asthma,renal insuficiency,metabolic disease,ulcus disease,chronical hepatitis,tuberculosis of lungs,bones or kidneys,hepatopathy), complication () and laboratory parameters ()
Results: Comparison of the mentioned parameters in non-surviving/surviving patients:
bronchopneumonia (36%/4%),perineal haemorrhage (36%/4%),hepatopathy (28%/4%),renal insuficiency (50%/16%),hypoalbuminemia (50%/16%),prior acute stroke (21%/12,5%),prior brain stroke (12,5%/7%).
Conclusion: Risk factors (bronchopneumonia,perineal haemorrhage,hepatopathy, RI,hypoalbuminemia) are markers of bad prognosis. The cardial markers (prior acute stroke and prior brain stroke) play a minor role.
Key words: colorectal cancer – perioperative risk - bronchopneumonia

The evaluation of the perioperative risk plays an irreplaceable role in a surgeon´s operative decision. Operative interventions mean considerable burden for the patient (operative risk of ischemia of the tissues and heart, risk of heart-failure and hypotension). Patients with heart disease are far more at risk than patients with normal cardiovascular findings. Preoperative examination and preparation made by a General practitioner are completed by an internist, cardiologist or anestesiologist who is responsible for a patient´s safety and quality of anestesiological care. The type of preoperative examination and preparation is determined by ACC/AHA based on a patient´s cardiovascular risk, operative risk and the functional efficiency of the patient. The examination needs to be done in an appropriate way so that the cardiovascular disease is diagnosed and evaluated exactly and these other test results influence preoperative preparation and care.

The conclusion of examination and recommendation with the aim of lowering perioperative risk is usually formulated by a cardiologist or internist.

We concetrate our effort here to patients with colerectal cancer (CC). The aim was to look after some parameters (risk factors/markers), that differentiate patients into surviving and non-surviving group. All patients were operated in the 1st. Department of Surgery, Hospital in Bratislava.

Patients

During the period from March 1.st 2005 to June 1.st 2005 medical records of operated patients with colorectal cancer were evaluated, in total, 60 patients (mean age: 73 ys), surviving (mean 38-96 ys) and non-surviving (mean 43–95 years). The diagnosis was bioptically confirmed.

Methods

All patients had CC confirmed by biopsy and were operated in the 1st Surgical Dept. of University Hospital in Bratislava.

Analysis was done restrospectively, time period: up to discharge from the hospital.

The risk of perioperative morbidity/mortality was judged by two ways: (1) by global score index (a number done by sume of points given to risk-parameters: demographic, cardiovascular or noncardiovascular risk factors and diseases, commorbidits, perioperative complications and laboratory parameters), in each patient (higher number means higher operative risk), see figure 1, 2, 3, 4, 5, and (2) by comparison of the two present (mentioned) parameters (dempographic, cardiovascular or noncardiovascular parameters and diseases, commorbidits, perioperative complications and laboratory parameters), in two subgroups of patients – surviving patients and non-surviving.