Key result
Early radical surgery within 3 months post-stroke does not increase short-term complications versus delayed surgery.
Why the study?
The appropriate timing of radical colorectal cancer surgery after new-onset cerebral infarction to optimize short-term outcomes was unclear.
Does early radical surgery (within 3 months) compared to nonearly surgery affect postoperative complications in colorectal cancer patients with new-onset cerebral infarction?
Cohort (n=395)
No
Does early radical surgery (within 3 months) compared to nonearly surgery affect postoperative complications in colorectal cancer patients with new-onset cerebral infarction?
Radical colorectal cancer surgery performed after 4 weeks of a new-onset cerebral infarction appears feasible and does not significantly increase perioperative complications compared to delaying surgery beyond 3 months.
Answers are grounded in this paper and cite their sources.
Early surgery post-cerebral infarction may be feasible without excess complications; leaves open need for RCTs to confirm optimal timing.
The purpose of our study was to compare the short-term outcomes of early (within 3 months after stroke) and nonearly (more than 3 months after stroke) radical colorectal cancer surgery to find an appropriate time to surgery for these colorectal cancer patients complicated with new-onset cerebral infarction. A retrospective analysis of patients with stroke who underwent curative colorectal cancer surgery between January 2010 and December 2020 was conducted. Propensity score matching (PSM) analysis was performed to overcome patient selection bias between the two groups. A total of 395 patients were reviewed. After PSM, 40 patients in the early group and 40 patients in the nonearly group were compared. The median time to surgery was 4 weeks in the early group. The overall incidence of postoperative complications between the groups was not significantly different (p = 0.745). The early group was associated with less intraoperative blood loss (50 vs. 100, p = 0.029 ml), with no difference in 30-day morbidity and mortality. Additionally, multivariate logistic regression analysis showed that previous abdominal surgery (p = 0.049) was an independent risk factor for postoperative complications after matching. Before matching, multivariate logistic analysis showed that ESRS (p = 0.028) and MRS (p = 0.039) were independent risk factors. Radical surgery after 4 weeks of cerebral infarction may be feasible for colorectal cancer patients with new onset stroke, as it appear not to increase the perioperative complications of Clavien-Dindo grade II or higher, while strengthening the preoperative evaluation and perioperative monitoring.
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Dou et al. (2023) conducted a cohort in Colorectal cancer complicated with newly onset cerebral infarction (n=395). Early radical surgery (within 3 months after stroke) vs. Nonearly radical surgery (more than 3 months after stroke) was evaluated on Short-term postoperative complications (Clavien-Dindo grade ≥ II) (p=0.745). Early radical surgery within 3 months of a new-onset cerebral infarction did not significantly increase the incidence of short-term postoperative complications compared to surgery after 3 months (12.5% vs. 15%, p=0.745).
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