Sezgin ZEREN, Zülfü BAYHAN, Cengiz Koçak, Mehmet EKİCİ, Şükrü DÜZGÜN

The Effect of Overweight Status on Total and Metastatic Number of Harvested Lymph Nodes During Colorectal Surgery

Objective: The aim of this study is to evaluate the relationship between higher body mass index (BMI) and harvested total or metastatic lymph node numbers in patients who underwent surgery for colorectal cancers.Methods: Between March 2014 and January 2016, totally 71patients who underwent laparoscopic or conventional surgery for colorectal cancer were evaluated retrospectively. The data of age, gender, BMI, surgical procedure, tumor localization , postoperative mortality status, total number of harvested and metastatic lymph node were collected. The patients having 24.9 (kg/m2) or lower BMI values were classified as normal (Group 1) and patients having BMI values of 25 or over were overweight (Group 2). Afterwards, the parameters between groups and the effect of higher BMI were analyzed.Results: The mean age of the patients was 64.5 ± 14 years. The average BMI value in group 1 was 22.3 (kg/m2) and 27.0 (kg/m2) in group 2. According to localisation of tumor, transverse colon was the rare region for both groups. The common regions for tumor localisation in group 1 were right colon, sigmoid colon and rectum. In group 2 the common localisation for tumors were rectum, right colon and sigmoid colon. There was no difference between groups about postoperative mortality rates (p > 0.05). The mean of the total number of harvested lymph nodes were 14 in group 1 and 12 in group 2. There were no relationship between BMI and tumor diameter, total or metastatic number of harvested lymph nodes.Conclusion: Higher BMI values does not effect the number of excised total or metastatic lymph nodes and tumor diameters. Therefore, the surgeons should not hesitate in overweight patients cancer surgery for dissecting adequate number of lymph nodes.Key words: Colorectal cancer, overweight, lymph node, surgery

Anahtar Kelimeler:

Kolorektal kanser, aşırı kilo, lenf nodu, cerrahi

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.Key words: Sedation, oral intake, postoperative nausea and vomiting

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Parkin DM, Bray F, Ferlay J, Pisani P. Global Cancer Statistics
CA J Clin 2005;55:74-108.
Türkoğlu A, Çetinkaya Z, Girgin M, et al. Kolorektal Kanserlerde
Prognostik Faktörler. Dicle Tıp Dergisi 2014; 41:724-731.
Uslu S, Erkasap S, Özçelik E, et al. Kolerektal kanserli hastalarda
serum adipositokin düzeyleri. Dicle Tıp Dergisi 2010;37:321-325.
Luglio G, De Palma GD, Tarquini R, et al. Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study. Ann Med Surg 2015;4:89-94.
Useros JV, Foncillas JG. Obesity and colorectal cancer: molecular
features of adipose tissue. J Transl Med 2016;14:21
Moug SJ, McCarthy K, Coode-Bate J, et al. Laparoscopic versus open surgery for colorectal cancer in the older person: A systematic review. Ann Med Surg 2015;4:311-318.
Simons-Morton DG, Donato K, Loria CM, et al. Obesity research and programs at the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2010;55:917-920.
Wu X, Cooper RS, Borecki I, et al. A combined analysis of genome wide linkage scans for body mass index from the National Heart, Lung, and Blood Institute Family Blood Pressure Program. Am J Hum Genet 2002;70:1247-1256.
Govaert JA, Lijftogt N, van Dijk WA, et al. Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry. Dutch Value Based Healthcare Study Group. J Surg Oncol 2016. doi: 10.1002/jso. 24187
Parnaby CN, Scott NW, Ramsay G, et al. Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection Br J Cancer 2015;113:212-219.
Hiki N, Fukunaga T, Yamaguchi T, et al. Increased fat content and body shape have little effect on the accuracy of lymph node retrieval and blood loss in laparoscopic distal gastrectomy for gastric cancer. J Gastrointest Surg 2009;13:626-633.
Wu XS, Wu WG, Li ML, et al. Impact of being overweight on the surgical outcomes of patients with gastric cancer: a meta-analysis. World J Gastroenterol 2013;19:4596-4606.
Linebarger JH, Mathiason MA, Kallies KJ, Shapiro SB. Does obesity impact lymph node retrieval in colon cancer surgery? Am J Surg 2010;200:478-482.
De Burlet KJ, van den Hout MF, Putter H, et al. Total number of lymph nodes in oncologic resections, is there more to be found? J Gastrointest Surg 2015;19:943-948.
Feo CV, Portinari M, Zuolo M, et al. Preoperative endoscopic tattooing to mark the tumour site does not improve lymph node retrieval in colorectal cancer: a retrospective cohort study. J Negat Results Biomed 2015;14:9.
Zhou X, Liu F, Lin C, et al. Hand assisted Laparoscopic Surgery Compared with open resection for mid and low rectal cancer: a case-matched study with long-term followup. World J Surg Oncol 2015;13:199.
Damadi AA, Julien L, Arrangoiz R, et al. Does obesity influence lymph node harvest among patients undergoing colectomy for colon cancer? Am Surg 2008;74:1073-1077.