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        Clinical validation of implementing Enhanced Recovery After Surgery protocol in elderly colorectal cancer patients

        Koh Wooree,이철승,배정훈,Abdullah Al-Sawat,이인규,진형용 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.1

        Purpose: The aim of this study was to evaluate the safety and feasibility of applying Enhanced Recovery After Surgery (ERAS) protocol in elderly colorectal cancer patients. Methods: The medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups. Results: In total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P=0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0±13.2 vs. OG, 11.7±23.0; P=0.130). In regression analysis, old age (>70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients. Conclusion: Implementing the ERAS protocol in patients aged >70 years is safe and feasible. High CRP (≥6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.

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        Surgical skin adhesive bond is safe and feasible wound closure method to reduce surgical site infection following minimally invasive colorectal cancer surgery

        이철승,Seung-Rim Han,Bong-Hyeon Kye,Jung Hoon Bae,Wooree Koh,In Kyu Lee,Do-Sang Lee,Yoon Suk Lee 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.3

        Purpose: Minimally invasive colorectal surgery had reduced the rate of surgical site infection. The use of surgical skin adhesive bond (2-octyl cyanoacrylate) for wound closure reduces postoperative pain and provides better cosmetic effect compared to conventional sutures or staples. But role of surgical skin adhesive bond for reducing surgical site infection is unclear. Our objective in this study was to evaluate the role of surgical skin adhesive bond in reducing surgical site infection following minimally invasive colorectal surgery. Methods: We performed a retrospective analysis of 492 patients treated using minimally invasive surgery for colorectal cancer at Seoul St. Mary’s Hospital, the Catholic University of Korea. Of these, surgical skin adhesive bond was used for wound closure in 284 cases and skin stapling in 208. The rate of surgical site infection including deep or organ/space level infections was compared between the 2 groups. Results: The rate of superficial surgical site infection was significantly lower in the group using skin adhesive (P = 0.024), and total costs for wound care were significantly lower in the skin adhesive group (P < 0.001). Conclusion: This study showed that surgical skin adhesive bond reduced surgical site infection and total cost for wound care following minimally invasive colorectal cancer surgery compared to conventional skin stapler technique. Surgical skin adhesive bond is a safe and feasible alternative surgical wound closure technique following minimally invasive colorectal cancer surgery

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