Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer

AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.METHODS This retrospective study analysed 652 patients undergoing surgery for stage Ⅰ-Ⅳ colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related survival.RESULTS Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients(53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL(median: 409 mg/dL; range: 143-1045 mg/d L). Preoperative fibrinogen values correlated with age(P = 0.003), completeness of tumour resection, potentially curative vs palliative(P < 0.001), presence of systemic metastasis(P < 0.001), depth of tumour invasion p T(P < 0.001), nodes involvement p N(P = 0.001) and CEA serum level(P < 0.001). The mean fibrinogen value(± SD) was 395.6 ± 120.4 mg/d L in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours(P = 0.045). The overall survival and tumourrelated survival were significantly higher in patients with fibrinogen values ≤ 400 mg/d L(P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall(P = 0.313) or tumour-related survival(P = 0.355) after controlling for other risk factors in a multivariate analysis.CONCLUSION Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.

Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection

BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.