Colorectal Surgery

5x-multiplier discharge algorithm cuts prescribed opioids after open intra-abdominal cancer surgery

In this single-center pragmatic RCT of 150 adults undergoing open abdominal cancer resections, the 5x-multiplier reduced median discharge OME to 25 mg versus 75 mg with the 3-tier model (P<0.001). Fourteen-day post-discharge opioid consumption was similar between groups (median 0 mg vs 10 mg, P=0.496), and patient satisfaction and symptom scores did not differ. Refill rates were numerically similar (24% vs 18%, P=0.426), supporting safety of lower discharge prescriptions in this population. 1

Perioperative prophylactic insulin (GIK) improves glycemic control in non-diabetic surgical patients

In this pilot RCT of 103 non-diabetic patients undergoing major abdominopelvic surgery, GIK increased perioperative euglycemia (42% vs 27%, P<.01) and reduced hyperglycemia (37% vs 48%, P<.05). Use of treatment insulin was lower with GIK (26% vs 45%, aRR 0.6, 95% CI 0.4–0.9) with no severe hypoglycemia and high protocol completion. Fewer complications occurred in the GIK arm (12% vs 21%), but confidence intervals were wide, so a definitive morbidity RCT is needed. 2

High-grade tumour budding independently predicts worse survival in stage II–III CRC

This meta-analysis of 43 studies (17,831 patients) found high-grade tumour budding associated with worse DFS (pooled HR 2.53) and OS (HR 2.40). Multivariable analyses across studies confirmed tumour budding as an independent prognostic factor in both stage II and III disease. Authors suggest routine TB reporting may improve risk stratification, but prospective trials are needed before using TB to direct therapy. 3