Nadir Adnan HACIM, Merve TOKOCİN, Serhat MERİC, Talar VARTANOGLU AKTOKMAKYAN, Soon Sup CHUNG, Yunus AKTİMUR, Haşim Furkan GÜLLÜ, Yuksel ALTINEL

Kırılganlık İndeksinin Tıkayıcı ve Perfore Kolon Kanseri İçin Yapılan Acil Kolektomi Sonuçları Üzerine Etkisi

Bu çalışma ile tıkayıcı ve perfore kolon kanseri nedeniyle acil cerrahi geçiren hastalarda kırılganlık indeksinin ameliyat sonuçları üzerine prediktif etkisini araştırmayı amaçladık. Şubat 2017 ile Ekim 2020 tarihleri arasında, tümörün tıkanması veya perforasyonu nedeniyle acil sağ ve sol hemikolektomi yapılan doksan-dokuz hasta retrospektif olarak değerlendirildi. 5-mFI skoru (modified frailty index), kırılganlık özelliklerinin her bir sayısının değerlendirmesiyle ölçüldü (her biri 1 puan; 0-5 puan) ve üç gruba ayrıldı (mFI=0, mFI=1 ve mFI≥2). Hasta popülasyonunun ortalama yaşı 65.21±13.84 idi. Erkek hastalar 60 (%60) idi. Daha yüksek mFI olan hastalarda albümin düzeyi daha düşük saptandı (3.86±0.63 vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). Artan mFI ile doğru orantıda, Clavien Dindo sınıflamması (CDC) [OR: 1.49,%95 CI: 0.82-2.75, p=0.2], morbidite [OR: 2.43,%95 CI: 0.50-13.98, p=0.3] ve anastomoz kaçağı [OR: 2,02,%95 CI: 0,63-6,65, p=0,2] artmış olduğu tespit edildi. Morbidite (16,%24.6 vs. 16,%47.1), p=0.041) ve mortalite (10,%15.4 vs. 9,%26.5, p=0.289) sağ kolon kanseri için daha fazla oranda görüldü. Stoma oluşumu genellikle sol taraf kolon kanserli hastalarda izlendi (29,%60 vs. 8,%23.5, p=0.001). 5-mFI skoru; morbidite, mortalite, uzun süre hastanede kalış ve reoperasyonlar dikkate alınarak acil kolon cerrahisi bulguları için muhtemel bir preoperatif prognostik belirteç olarak düşünülebilinir. Sağ taraflı tümörlerde morbidite ve mortalite ve sol taraflı tümörlerde stoma oluşumu daha artmış görülmeşine rağmen, 5-mFI skoru hastalarda kolon kanser yerleşim yerine bağımlı olmadan değerlendirilebilir.

Anahtar Kelimeler:

Kırılganlık, Kolektomi, Acil

The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer

This study aimed to analyze the predictive impact of frailty index and patterns of outcomes in patients with obstructing and perforated colon cancer who had emergency surgery. The nighty-nine patients who underwent right and left hemicolectomy were retrospectively evaluated within emergency conditions such as obstruction or perforation of tumor between February 2017 and October 2020. The 5-mFI (modified frailty index) score was measured by multiplying each number of frailty features (1 point per each existence; 0 - 5 points) and categorized into three groups (mFI=0, mFI=1, and mFI ≥ 2). The average age of the patient population was 65.21±13.84 years old. The male patients were 60 (60%). Albumin level was seen lower in patients who had higher mFI (3.86±0.63vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). The predictive outcomes regarding the mFI potentially showed increased Clavien Dindo classification (CDC) [OR: 1.49, 95%CI: 0.82-2.75, p=0.2], morbidity [OR: 2.43, 95%CI: 0.50-13.98, p=0.3], and leakage [OR: 2.02, 95%CI: 0.63-6.65, p=0.2]. The morbidity (16, 24.6% vs. 16, 47.1%), p=0.041) and mortality (10, 15.4% vs. 9, 26.5%, p=0.289) were more likely seen for right sided tumors. Stoma formation was seen more likely for left sided tumors (29, 60% vs. 8, 23.5%, p=0.001). The 5-mFI score might be assumed as a preoperative prognostic tool for emergency colon surgery considering morbidity, mortality, prolonged hospitalization, and reoperation. Although morbidity and mortality in right-sided tumors and stoma formation are higher in left-sided tumors, 5-mFI score can be evaluated in patients regardless of colon cancer location.

Keywords:

Frailty, Colectomy, Emergency,

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