Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery; a randomised controlled pilot study (ISRCTN 11799696) Fluid optimisation for emergency surgery

<b>Background:</b> Emergency abdominal surgery carries a high risk of postoperative morbidity and mortality. Goal directed therapy has been advocated to improve outcome in high-risk surgery. The aim of the present pilot study was to examine the effect of goal directed therapy using fluid alone on postoperative renal function and organ failure score in patients undergoing emergency abdominal surgery. <b>Methods:</b> This prospective randomised pilot study included patients over the age of 50 undergoing emergency abdominal surgery. In the intervention group pulse pressure variation measurements were used to guide fluid boluses of 6% Hydroxyethylstarch 130/0.4. The control group received standard care. Serum urea, creatinine and cystatin C levels were measured prior to and at the end of surgery and postoperatively on day 1, day 3 and day 5. <b>Results:</b> Thirty patients were recruited. One patient died prior to surgery and was excluded from the analysis. The intervention group received a median of 750ml of hydroxyethylstarch. The peak values of postoperative urea were 6.9 (2.7–31.8) vs. 6.4 (3.5–11.5)mmol/l (p=0.425), creatinine 100 (60–300) vs. 85 (65–150) μmol/l (p=0.085) and cystatin C 1.09 (0.66–4.94) vs. 1.01 (0.33–2.29)mg/dl (p=0.352) in the control and intervention group, respectively. <b>Conclusions:</b> In the present pilot study replacing the identified fluid deficit was not associated with a change in renal function. These results do not preclude that goal directed therapy using fluid alone may have an effect on renal function but they would suggest that the effect size of fluid optimisation alone on renal function is small

Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer

<p><b>Background/aims</b></p> <p>The aim of the study was to examine the value of the combination of an elevated C-reactive protein and hypoalbuminaemia (GPS) in predicting cancer-specific survival after resection for colon and rectal cancer.</p> <p><b>Materials and methods</b></p> <p>The GPS was constructed as follows: Patients with both an elevated C-reactive protein (>10 mg/l) and hypoalbuminaemia (<35 g/l) were allocated a score of 2. Patients in whom only one or none of these biochemical abnormalities was present were allocated a score of 1 or 0, respectively.</p> <p><b>Results</b></p> <p>A GPS of 1 (n = 109) was mainly due to an elevated C-reactive protein concentration and the remainder due to hypoalbuminaemia. In those patients with a GPS of 1 due to hypoalbuminaemia (n  = 16), the 3-year overall survival rate was 94% compared with 62% in those patients with a GPS of 1 due to an elevated C-reactive protein concentration (n = 93, p = 0.0094). Therefore, the GPS was modified such that patients with hypoalbuminaemia were assigned a score of 0 in the absence of an elevated C-reactive protein. On univariate analysis of those patients with colon and rectal cancer, the modified GPS (p< 0.0001) was significantly associated with overall and cancer specific survival. On univariate survival analysis of those patients with Dukes B colon and rectal cancer, the modified GPS (p< 0.01) was significantly associated with overall and cancer specific survival.</p> <p><b>Conclusion</b></p> <p>The results of the present study indicate that the GPS, before surgery, predicts overall and cancer-specific survival after resection of colon and rectal cancer.</p&gt

Preoperative but not postoperative systemic inflammatory response correlates with survival in colorectal cancer

<p><b>Background:</b></p> <p>The aim of the present study was to evaluate the relationship between the preoperative and postoperative systemic inflammatory response and survival in patients undergoing potentially curative resection for colorectal cancer.</p> <p><b>Methods:</b></p> <p>One hundred and eighty patients with colorectal cancer were studied. Circulating concentrations of C-reactive protein (CRP) were measured before surgery and in the immediate postoperative period.</p> <p><b>Results:</b></p> <p>The peak in CRP concentration occurred on day 2 (P < 0·001). During the course of the study 59 patients died, 30 from cancer and 29 from intercurrent disease. Day 2 CRP concentrations were dichotomized. In univariable analysis, advanced tumour node metastasis stage (P = 0·002), a raised preoperative CRP level (P < 0·001) and the presence of hypoalbuminaemia (P = 0·043) were associated with poorer cancer-specific survival.</p> <p><b>Conclusion:</b></p> <p>Preoperative but not postoperative CRP concentrations are associated with poor tumour-specific survival in patients undergoing potentially curative resection for colorectal cancer.</p&gt