| Sažetak | Uvod: Karcinom debelog i završnog crijeva (kolorektalni karcinom) treće je po učestalosti u svijetu, nakon raka dojke i raka pluća. Prema procjenama Svjetske zdravstvene organizacije za istraživanje raka, godišnje od njega oboli gotovo 2 milijuna osoba, a umre 0,95 milijuna. Karcinom debelog i završnog crijeva najučestalija je zloćudna bolest u Hrvatskoj. Godišnje prosječno oboli oko 3600 osoba, od čega oko 60% muškaraca. Češći je kod osoba starije životne dobi, međutim skoro 1/5 oboljelih je mlađa od 60 godina. Prema posljednjim podacima Registra za rak, u 2019. godini od kolorektalnog raka oboljelo je 3660 osoba, a prosječna dob prilikom oboljenja bila je 69 godina. U Hrvatskoj po smrtnosti od zloćudnih bolesti kolorektalni je rak na drugom mjestu, nakon raka pluća. Godišnje od njega umire oko 2100 osoba, a također 60% muškaraca. Petogodišnje preživljenje bolesnika sa rano otkrivenim kolorektalnim karcinomom je do 90%, dok je 5-godišnje preživljenje bolesnika s recidivnim i metastatskim kolorektalnim karcinomom manje od 12%. Prema posljednjim podacima Registra za rak samo 11% slučajeva raka debelog crijeva je otkriveno u lokaliziranom stanju dok su kod 13% osoba prilikom postavljanja dijagnoze već prisutne metastaze. Bolesnici s kolorektalnim karcinomom često zahtijevaju perioperativno transfuziju krvi i nadoknade željeza zbog anemije kroničnog gubitka krvi. Nema opće suglasnosti o utjecaju transfuzija krvi na postoperativne komplikacije: cijeljenje rane, infekcijske komplikacije, reoperacije zbog dehiscencije, dužinu boravka u bolnici.
Cilj: Cilj ovog istraživanja je ispitati učestalost primjene perioperativne transfuzije koncentrata eritrocita zbog anemije u bolesnika s kolorektalnim karcinomom te usporediti učestalost komplikacija i dužinu boravka u bolnici između bolesnika koji jesu i nisu primili transfuzije eritrocita.
Metode istraživanja: Provedeno je retrospektivnog istraživanja u razdoblju od 2 godine od 2020.-2021. godine. U istraživanju su obrađeni podaci 120 bolesnika s dijagnozom kolorektalnog karcinoma koji su hospitalizirani, liječeni i operirani na odjelu Kirurške onkologije, Klinike za tumore, KBC Sestre milosrdnice. Bolesnici su bili podijeljeni u dvije skupine: skupina koja je primala transfuziju koncentrata eritrocita perioperativno i skupina koja nije primala transfuzije koncentrata eritrocita. Analizirani su sljedeći parametri: dob, spol, kirurška metoda, laboratorijski nalazi (kompletna krvna slika: pomaže u dijagnozi različitih medicinskih stanja, uključujući anemiju, infekcije i dr., CRP-C-reaktivni protein: marker kod kojeg povećana razina ukazuje na prisutnosti upale u tijelu, SE - sedimentacija eritrocita: povećane stope ukazuju na prisutnost upale u tijelu, PCT - procalcitonin: povećane razine PCT-a mogu ukazivati na teže bakterijske infekcije), perioperativno adjuvantno liječenje, radioterapija ili kemoterapija, u razdoblju od trenutka kada je odlučeno da bolesnik ide na operativni zahvat do oporavka nakon operativnog zahvat kada se bolesnika otpušta na kućnu njegu, učestalost komplikacija i duljina boravka u bolnici.
Rezultati: Ispitivanje je obuhvatilo 120 bolesnika (46 žena i 74 muškarca) s adenokarcinomom crijeva, s medijanom dobi od 69 godina. Muškarci su bili zastupljeniji među mlađima od 69 godina (54%; P = 0,04), a 3. stadij bolesti češći je kod mlađih bolesnika (43%; P = 0,04). Nisu uočene značajne razlike u dužini boravka u bolnici prema dobi i spolu. Perioperacijski krvni parametri pokazali su statistički značajan pad eritrocita i hemoglobina, uz porast upalnih parametara. Stariji bolesnici imali su značajan pad eritrocita 1. i 3. poslijeoperacijski dan (P < 0,01), dok su žene imale niže vrijednosti eritrocita i hemoglobina u odnosu na muškarce prije i nakon operacije (P < 0,01).
Zaključak: Rezultati istraživanja potvrđuju da perioperativne transfuzije značajno utječu na ishode bolesnika. Transfuzije su povezane s dužim oporavkom i češćim komplikacijama, što potvrđuje hipoteze da bolesnici koji primaju eritrocitne transfuzije perioperativno imaju više komplikacija i duže borave u bolnici u usporedbi s onima koji ih ne primaju. Nalazi naglašavaju važnost pažljivog razmatranja indikacija za transfuziju i potrebu za daljnjim istraživanjima radi optimizacije transfuzijskih protokola. |
| Sažetak (engleski) | Introduction: Colorectar carcinoma (CRC) is the third most common cancer site in the World, after breat cancer and lung cancer. According to estimates by the World Health Organization for Cancer Research, almost 2 milion people are diagnosed with it annually, and 0.95 milion die. Colon and colorectal cancer is the most common malignant disease in Croatia. On average, about 3600 people are affected annualy, of which about 60% are men. It is more common in the elderly, but almost 1/5 of patients are younger than 60 years of age. According to the latest dana from Cancer registry, in 2019, 3660 people were diagnosed with colorectal cancer, and the average age at the time of the disease was 69 years. In Croatia, colorectal cancer i sin second place in terms of mortality from malignant diseases, after lung cancer. About 2100 people die from it annualy, and also 60% of men. The five year survival rate of patients with early detection of colorectal cancer is up to 90%, while the 5 year survival of patients with reccurent and metastatic colorectal cancer is less than 12%. According to the latest dana from the Cancer registry, only 11% of colorectal cancer are detected in a localised state, while in 13% of people metastases are alredy present at diagnosis. Patients with colorectal cancer often require perioperative blood transfusions and iron replacement due to anemia, chronic blood loss. There is no general agreement on the effect of blood transfusions on postoperative complications, resurgeries due to dehiscence, length of hospital stay.
Aim: The aim of this study was to examine the frequency of perioperative transfusion of erythrocyte concentrate due to anemia in patients with colorectal cancer and to compare the frequency of complications and length of hospital stay between patients who received and did not receive erythrocyte transfusions.
Methods: A retrospective study was conducted in a period of 2 years from 2020 to 2021. The study will process the data of 120 patients diagnosed with colorectal cancer who were hospitalized, treated and operated on at the Department of Surgical Oncology, Clinic for Cancer, University Hospital Sister of Mercy . Patients were divided into two groups: the group that received the transfusion of erythrocyte concentrate perioperatively and the group that did not receive transfusions of erythrocyte concentrate. Data to be analyzed: age, gender, surgical method, laboratory findings (complete blood count: helps diagnose various medical conditions, including anemia, infections, etc., CRP-C-reactive protein: a marker in which increased levels indicate the presence of inflammation in the body, SE - erythrocyte sedimentation rate: increased rates indicate the presence of inflammation in the body, PCT - procalcitonin: increased levels of PCT may indicate more severe bacterial infections), perioperative adjuvant treatment, radiotherapy or chemotherapy, in the period from the moment it was decided that the patient should undergo surgery until recovery after surgery when the patient is discharged for home care, the frequency of complications and the length of stay in the hospital.
Results: The study included 120 patients (46 women and 74 men) with colorectal adenocarcinoma, with a median age of 69 years. Men were more represented among those younger than 69 years (54%; P = 0.04), and stage 3 of the disease was more common in younger patients (43%; P = 0.04). No significant differences in hospital stay duration were observed by age or gender. Perioperative blood parameters showed a statistically significant decrease in erythrocytes and hemoglobin, along with an increase in inflammatory markers. Older patients had a significant drop in erythrocytes on the 1st and 3rd postoperative days (P < 0.01), while women had lower erythrocyte and hemoglobin levels compared to men before and after surgery (P < 0.01).
Conclusion: The study's results confirm that perioperative transfusions significantly impact patient outcomes. Transfusions are associated with longer recovery times and more frequent complications, supporting the hypotheses that patients receiving perioperative erythrocyte transfusions experience more complications and longer hospital stays compared to those who do not. These findings highlight the importance of careful consideration of transfusion indications and the need for further research to optimize transfusion protocols. |
