This study compared surgical outcomes for colorectal cancer patients who were immunocompromised versus those who were not. The authors found that 75% of patients were immunocompromised due to factors like old age, chemotherapy, radiation, or low protein levels. These patients had worse outcomes, with fistula formation occurring in 23-30% of cases compared to 9-12% for immunocompetent patients. The study concluded that surgeons should consider creating a stoma instead of an anastomosis for immunocompromised patients to avoid life-threatening complications from procedures like anastomosis that have higher risks in immunocompromised patients.

1. THE CHOICE OF PERFORMING A STOMA VERSUS AN ANASTOMOSIS IN
IMMUNE COMPROMISED COLORECTAL CANCER PATIENTS: OLD AGE,
CHEMOTHERAPY ,RADIOTHERAPY AND LOW PROTEIN LEVELS AS
PROGNOSTIC FACTORS FOR THE SURGICAL OUTCOME
Authors : Sinziana Ionescu,* Eugen Bratucu*,
*First Clinic of General surgery and surgical oncology from the Bucharest Oncology
Institute, “Carol Davila” University of Medicine and Pharmacy , Bucharest, Romania
Background: The authors considered of interest to study
and discuss the methods of surgical treatment options in
patients with colo-rectal cancer and associated factors
which usually dramatically impact on the surgical
outcome in the postoperative period, and sometimes on
survival itself , such as: old age of more than 65 years,
chemotherapy and radiotherapy treatments before the
surgical moment and low opportunities of good wound
healing , such as hypoproteinemia and malnutrition.
Material and methods: We performed a retrospective
study from 01/01/2010 to 27/12/2017 in which we reviewed
2316 hospital re-admissions in our clinic (First Clinic of
General Surgery and Surgical Oncology from the
Bucharest Oncology Institute, Bucharest, Romania), out
of which we selected 711 patients with colo-rectal cancers .
Consequently, we compared the outcomes of two separate
groups, patients without any clinical or laboratory proof
of immunodepression , (except the diagnosis of colo-rectal
cancer) versus patients immune-compromised with one
or more elements of the following: old age, chemotherapy ,
radiotherapy and hypo-proteinemia and malnutrition.
The parameters followed in the postoperative period were
: fistula formation, paralytic ileus with cardiac and
respiratory complications, intra-abdominal abscess
formation , peritonitis and postoperative days in the ICU
unit or in the hospital.
Results: Out of the total, 75% were immunocompromised
patients with poor prognosis and bad general estate before
the surgical intervention. 15% had more than 80 years of
age with associated pathology .We demonstrated that the
choice of ileostomy or colostomy, with the inherent
decision not to do an anastomosis in cases of great risk of
performing postoperative complications was life saving.
We found that in our group, fistula formation in
immunocompetent patients was between 9-12 % and in
immunodepressed patients it was 23-30%( when one or
more factors of bad healing prognosis were associated).
Conclusions: The surgeon should refrain from choosing an
anastomosis even if the technical conditions allow it ,
because the appearance of complications in cancer
patients is much more frequent than it is in the general
population and cancer itself decreases the immunity
defences. Moreover, associated factors, such as old age ,
recent chemotherapy or radiotherapy treatments ,hypo-
proteinemia and malnutrition add odds to the possibility
of serious postoperative complications which can be life-
threatening in an immunodepressed patient.
Relapsed colonic tumour, after surgery and
chemotherapy
0
50
100
150
200
250
anastomoses
colostomies
abscess evacuation
rezection of the
tumour blocks other
anastomoses colostomies
abscess
evacuation
rezection of the
tumour blocks
other
Series1 215 223 90 113 70
Types of surgical interventions for
colorectal tumours
0
5
10
15
20
25
30
35
40
sepsis and
peritonitis sepsis and pleural
effusion sepsis peritonitis
and pleural
effusion
sepsis and other
pathologies
sepsis and peritonitis
sepsis and pleural
effusion
sepsis peritonitis and
pleural effusion
sepsis and other
pathologies
Series1 27 17 20 36
Series2
Sepsis and its most frequent
associations
0
1
2
3
4
5
6
7
g
/
dL
Mean values of proteins and
albumin pre op
Proteins albumin
Dark yellow general group
Blue fistula group
0
50
100
150
200
250
300
350
400
450
500
1 2 3 4 5 6 7 8 9 10 11 12 13
The evolution of the values of C reactive protein in
days 1,3,5,7 in patients with fistula
Blue day 1
Red day 3
Yellow day 5
Green day 7
0
2
4
6
8
10
12
14
Patients with fistula and infectious
complications
Fistula Fistula and infection Patients which died