Kazutoshi Takagi

Inflammation-based Prognostic Score Is a Novel Predictor of Postoperative Outcome in Patients With Colorectal Cancer

Objective:To investigate the significance of preoperative Glasgow prognostic score (GPS) for postoperative prognostication of patients with colorectal cancer. Background:Recent studies have revealed that the GPS, an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the GPS in the field of colorectal surgery. Methods:The GPS was calculated on the basis of admission data as follows: patients with an elevated level of both CRP (>10 mg/L) and hypoalbuminemia (Alb <35 g/L) were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. Prognostic significance was analyzed by univariate and multivariate analyses. Results:A total of 315 patients were evaluated. Kaplan-Meier analysis and log-rank test revealed that a higher GPS predicted a higher risk of postoperative mortality (P < 0.01). Univariate analyses revealed that postoperative TNM was the most sensitive predictor of postoperative mortality (odds ratio, 0.148; 95% confidence interval, 0.072–0.304; P < 0.0001). Multivariate analyses using factors such as age, sex, tumor site, serum carcinoembryonic antigen, CA19-9, CA72-4, CRP, albumin, and GPS revealed that GPS (odds ratio, 0.165; 95% confidence interval, 0.037–0.732; P = 0.0177) was associated with postoperative mortality. Conclusions:Preoperative GPS is considered to be a useful predictor of postoperative mortality in patients with colorectal cancer.

Influence of Inflammation-Based Prognostic Score on Mortality of Patients Undergoing Chemotherapy for Far Advanced or Recurrent Unresectable Colorectal Cancer

Background:Recent studies have revealed that the modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the mGPS in patients undergoing chemotherapy for far-advanced or recurrent unresectable colorectal cancer (AR-UCRC). Objective:To demonstrate the influence of the mGPS for prognostication of patients undergoing chemotherapy for AR-UCRC. Methods:The mGPS was calculated as follows: patients with an elevated level of CRP (>1.0 mg/dL) were allocated a mGPS of 1 or 2 depending on the absence or presence of hypoalbuminemia (<3.5 g/dL) and patients showing no elevated level of CRP (≤1.0 mg/dL) were allocated a mGPS of 0. Prognostic significance was analyzed by Kaplan-Meier, univariate, and multivariate analyses. Results:One hundred twelve patients who had undergone chemotherapy for AR-UCRC with regimens such as FOLFIRI (5-fluorouracil/l-leucovorin/irinotecan hydrochloride) or FOLFOX (5-fluorouracil/oxialiplatin) were evaluated retrospectively. Kaplan-Meier analysis and log-rank test revealed that mGPS 2 predicted a higher risk of mortality than mGPS 0 or 1 (P < 0.0001). Univariate analyses revealed that the neutrophil ratio (P = 0.0411), CA 19–9 (P = 0.0473), CRP (P = 0.0477), albumin (P = 0.0043), and mGPS (0, 1/2) (P < 0.0001) were associated with mortality. Multivariate analyses using these 5 factors revealed that only mGPS (0, 1/2) (odds ratio: 6.071; 95% CI: 1.625–22.68; P = 0.0073) was an independent risk factor of mortality. Conclusions:mGPS is an important and independent predictor of mortality in patients undergoing chemotherapy for AR-UCRC.BACKGROUND Recent studies have revealed that the modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the mGPS in patients undergoing chemotherapy for far-advanced or recurrent unresectable colorectal cancer (AR-UCRC). OBJECTIVE To demonstrate the influence of the mGPS for prognostication of patients undergoing chemotherapy for AR-UCRC. METHODS The mGPS was calculated as follows: patients with an elevated level of CRP (>1.0 mg/dL) were allocated a mGPS of 1 or 2 depending on the absence or presence of hypoalbuminemia (<3.5 g/dL) and patients showing no elevated level of CRP (< or =1.0 mg/dL) were allocated a mGPS of 0. Prognostic significance was analyzed by Kaplan-Meier, univariate, and multivariate analyses. RESULTS One hundred twelve patients who had undergone chemotherapy for AR-UCRC with regimens such as FOLFIRI (5-fluorouracil/l-leucovorin/irinotecan hydrochloride) or FOLFOX (5-fluorouracil/oxialiplatin) were evaluated retrospectively. Kaplan-Meier analysis and log-rank test revealed that mGPS 2 predicted a higher risk of mortality than mGPS 0 or 1 (P < 0.0001). Univariate analyses revealed that the neutrophil ratio (P = 0.0411), CA 19-9 (P = 0.0473), CRP (P = 0.0477), albumin (P = 0.0043), and mGPS (0, 1/2) (P < 0.0001) were associated with mortality. Multivariate analyses using these 5 factors revealed that only mGPS (0, 1/2) (odds ratio: 6.071; 95% CI: 1.625-22.68; P = 0.0073) was an independent risk factor of mortality. CONCLUSIONS mGPS is an important and independent predictor of mortality in patients undergoing chemotherapy for AR-UCRC.

Preoperative thrombocytosis is associated with survival after surgery for colorectal cancer

To evaluate the influence of preoperative thrombocytosis on survival after surgery in patients with colorectal cancer (CRC).

Right internal jugular vein is recommended for central venous catheterization.

ABSTRACT Background: The internal jugular vein (IJV) is one of the recommended sites for safe insertion of a central venous catheter (CVC). Although CVC insertion via the IJV has a lower risk of severe complications such as pneumothorax and arterial bleeding than insertion via the subclavian vein, few reports have provided concrete evidence for the safety of a right-sided approach. Purpose: To examine whether a right-sided approach, rather than a left-sided one is superior for CVC insertion via the IJV. Methods: A retrospective study was performed to compare the right IJV with the left in terms of characteristics such as vertical and horizontal diameters, depth from the skin, and the relationship between the IJV and the common carotid artery (CCA) using the same computed tomography axial slice. Results: From April 2006 to September 2008, 100 patients (50 male and 50 female) who underwent CVC insertion via the IJV before surgery for colorectal cancer were enrolled. Vertical and horizontal diameters of the right IJV were significantly larger than those of the left IJV [right: left (cm), 1.51 ± 0.41 vs 1.13 ± 0.34, p <.0001, 1.54 ± 0.36 vs 1.08 ± 0.33, p <.0001], respectively. The right IJV runs more superficially than the left IJV [right: left (cm), 1.74 ± 0.60 vs 1.87 ± 0.56, p <.0001]. Conclusions: Because the right IJV has a much wider diameter and runs more superficially than the left IJV, a right-sided approach is more acceptable than a left-sided one for CVC insertion via the IJV.

Total Parenteral Nutrition Is a Major Risk Factor for Central Venous Catheter-Related Bloodstream Infection in Colorectal Cancer Patients Receiving Postoperative Chemotherapy

Purpose: To clarify the risk factors for central venous catheter-related bloodstream infection (CVCR-BSI) in patients receiving chemotherapy after surgery for colorectal cancer (CRC). Methods: CVCR-BSI was evaluated retrospectively from a database of patients who had received postoperative chemotherapy using central venous catheters (CVC). Results: One hundred and nine patients received 542 CVC for a total of 5,558 catheter-days. There were no significant differences in background between the patients who had CVCR-BSI and those who did not, except for the administration of total parenteral nutrition (TPN) (p < 0.0001). Moreover, univariate analyses (using factors including type of catheter, sex, age, troubles with insertion, kinds of disinfectant, kinds of catheter, length of inserted catheter, term of catheter insertion and administration of TPN) revealed that the administration of TPN (odds ratio, 12.74; 95% CI, 2.489–62.26; p = 0.0023) was the only risk factor for CVCR-BSI. Conclusions: TPN is a major risk factor for CVCR-BSI in CRC patients receiving postoperative chemotherapy.

Inflammation-based prognostic system predicts survival after surgery for stage IV colorectal cancer.

BACKGROUND The aim of this study was to estimate whether the Glasgow prognostic score (GPS) is useful for predicting the survival of patients after surgery for stage IV colorectal cancer (CRC). METHODS The GPS was calculated on the basis of admission data as follows: patients with both an increased C-reactive protein (CRP) level (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2, and patients showing one or none of these abnormalities were allocated a score of 1 or 0, respectively. RESULTS A total of 108 patients with stage IV CRC were enrolled. Although multivariate analyses showed that tumor pathology, subclass of stage IV CRC, and the GPS were associated with overall survival, the GPS could divide the patients into 3 independent groups showing significant differences in postoperative survival (P = .018). CONCLUSIONS The GPS is not only one of the most significant clinical characteristics associated with the overall survival of patients with stage IV CRC, but also a useful indicator that is capable of dividing such patients into 3 independent groups before surgery.

Femoral Venous Catheterization Is a Major Risk Factor for Central Venous Catheter-Related Bloodstream Infection

Background: Bloodstream infection is a major complication associated with central venous catheters (CVCs). However, there have been few studies of the risk factors for catheter-related bloodstream infection in patients who undergo colorectal surgery (CRS). Purpose: To disclose the risk factors for catheter-related bloodstream infection in CRS. Methods: Catheter-related bloodstream infection was evaluated retrospectively from a database of patients who had undergone CRS. Results: Three hundred-fifty patients received 423 CVCs for a total of 7,760 catheter days. Thirty-nine cases of catheter-related bloodstream infection (5.03 per 1,000 catheter days) were diagnosed. There were no significant differences in background between patients with or without catheter-related bloodstream infection, with the exception of the term of catheter insertion (24.6 ± 7.0 days vs.17.7 ± 0.6 days, P =. 0151). However, univariate analysis using factors of sex, age, insertion difficulty, length of the inserted catheter, term of catheter insertion, administration of chemotherapy, administration of total parenteral nutrition (TPN), kind of disinfectant, degree of surgical insult, and type of catheter revealed that use of a femoral venous catheter was an independent risk factor for catheter-related bloodstream infection (odds ratio [OR] = 3.175; 95% confidence interval [CI], 1.103–9.139; P =. 0322). Conclusions: Use of femoral venous catheters is a major risk factor for catheter-related bloodstream infection in CRS.

Comparison of 0.05% Chlorhexidine and 10% Povidone-Iodine as Cutaneous Disinfectant for Prevention of Central Venous Catheter-Related Bloodstream Infection: A Comparative Study

Background: The Centers for Disease Control and Prevention guideline recommended the use of 2% chlorhexidine as a percutaneous disinfectant for central venous catheter (CVC) insertion. However, in Japan, 0.05% chlorhexidine is commonly used as well as 10% povidone-iodine, instead of 2% chlorhexidine. Purpose: It was the aim of this study to examine whether the use of 0.05% chlorhexidine is inferior to conventional 10% povidone-iodine as a percutaneous disinfectant for preventing CVC-related bloodstream infection (CVC-RBSI). Methods: Between September 2006 and July 2008, the time interval from insertion to development of CVC-RBSI was compared prospectively between patients prepared with 0.05% chlorhexidine (group 1, n = 286 CVCs) and those prepared with conventional 10% povidone-iodine (group 2, n = 298 CVCs). Results: Two hundred and thirty-nine patients received 584 CVCs for a total of 6,205 catheter-days. CVC-RBSI (3.22 per 1,000 catheter-days) was diagnosed in 20 cases. There were no significant differences in patient background factors between group 1 and 2, except for blood culture positivity (p = 0.0450). However, Kaplan-Meier analysis and the log rank test revealed no significant difference between group 1 and 2 in the time interval from insertion until development of CVC-RBSI. Conclusions: Use of 0.05% chlorhexidine is not inferior to conventional 10% povidone-iodine as a cutaneous disinfectant for the prevention of CVC-RBSI.

External jugular venous catheterization with a Groshong catheter for central venous access.

The Groshong catheter (GC) is commonly used as a peripherally inserted central catheter (PICC), and the external jugular vein (EJV) is not a common route for central venous access (CVA). Therefore, external jugular venous catheterization (EJVC) using a GC is rare. However, our experience has shown that this procedure is safe and simple for CVA.

Usefulness of Intraoperative Observation Using a Fluorescence Imaging Instrument for Patients With Nonocclusive Mesenteric Ischemia

The authors evaluated the usefulness of intraoperative photodynamic eye (PDE) observation in patients with nonocclusive mesenteric ischemia (NOMI). Between February 2012 and July 2013, 6 patients who had undergone emergency surgery for NOMI were enrolled. Intraoperative PDE observation was performed to decide the adequate length of bowel resection including all skipped dark spots, which could not be detected as ongoing mucosal ischemic changes under visible light observation. All ongoing mucosal ischemic changes were easily detected as dark spots using PDE observation in all 6 patients. The mean length of adequate ileal resection (92 ± 48 cm) was significantly longer than that of ischemic ileum (85 ± 50 cm) (mean ± SD) (P = 0.043). After resection of an adequate length of bowel, all the patients had a good course until discharge without incidents due to residual bowel ischemia, except for 1patient who died. PDE observation is useful for deciding the adequate length of bowel to resect, including ongoing mucosal ischemic changes that cannot be detected under visible light observation. In patients with NOMI, resection of an adequate length of bowel is necessary to prevent postoperative incidents due to residual bowel ischemia.