(Vienna, 16 October 2023) A research team at the Comprehensive Cancer Center of MedUni Vienna and Vienna General Hospital has published a study investigating the influence of chronic diseases on the occurrence of surgical or medical complications in oncological bowel surgery and how these affect long-term survival. It was found that although the number and severity of concomitant diseases influences the occurrence of medical or surgical complications, this does not have a negative impact on long-term survival in sicker individuals. Existing concomitant diseases should therefore not cause withholding of surgery. The data analysis was carried out by researchers from the University Department of Visceral Surgery at MedUni Vienna and Vienna General Hospital in collaboration with the Floridsdorf Clinic. The results were published in the International Journal of Surgery.
Colorectal cancer particularly affects older people, who often simultaneously suffer from chronic diseases that are equally challenging to treat. As the median age of patients with colorectal cancer is 70 years, cardiovascular, respiratory and metabolic diseases are common, thereby necessitating individualized treatment concepts. Additionally to oncological and surgical evaluation, preoperative assessment by anesthesiologists is equally important as subsequent nursing and physiotherapeutic treatment in order to keep the hospital stay as short as possible. However, operations for rectal cancer in particular are technically demanding due to the anatomical conditions in the pelvis and may entail a longer convalescence.
Lukas Schlager, assistant physician at the Clinical Department of Visceral Surgery, investigated the influence of chronic diseases on the occurrence of surgical and medical complications during surgery on the left colon and rectum and the impact of perioperative complications on long-term survival, by analysing patient data from Vienna General Hospital and the Floridsdorf Clinic. It was found that patients with multiple concomitant diseases suffered more serious complications in both centers, but that these seldomly had a surgical-technical origin and were rather medical complications such as pneumonia. Although patients with multiple concomitant diseases had poorer long-term survival, as expected, the occurrence of complications after surgery in this patient group was not shown to be a detriment to long-term outcome. It was also confirmed that minimally invasive surgical methods ("keyhole surgery") are standard in both centers studied and that the rate of surgical complications is low compared to results published from other centers.
Treatment in specialized centers
The data suggest that multidisciplinary care and adequate treatment of complications after oncologic surgery are warranted in specialized centers, even for patients with chronic disease. Lukas Unger, principal investigator at the Clinical Department of Visceral Surgery and currently a senior clinical fellow at the Department of Colorectal Surgery at Oxford University Hospitals, said, "Our study shows the importance of multidisciplinary management of patients with concomitant diseases before and after oncologic surgery to achieve optimal outcomes. Successful treatment is teamwork and should take place in specialized centers to ensure ideal conditions. Existing concomitant diseases should not cause surgery to be automatically withheld."
Publication: International Journal of Surgery
The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study.
Lukas Schlager, Matthias Monschein, Jessica Schüller, Michael Bergmann, Christoph Krall, Peter Razek, Anton Stift, Lukas W. Unger
International Journal of Surgery, October 5, 2023. | DOI: 10.1097/JS9.0000000000000734