The relation of preoperative 25-OH Vitamin D Levels with Postoperative Complications in Patients undergoing Colorectal Cancer Surgery

doi:10.21203/rs.3.rs-130457/v1

Download PDF

Research Article

The relation of preoperative 25-OH Vitamin D Levels with Postoperative Complications in Patients undergoing Colorectal Cancer Surgery

https://doi.org/10.21203/rs.3.rs-130457/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: To investigate the effect of preoperative 25-OH vitamin D levels on postoperative complications in patients undergoing colorectal cancer surgery.

Methods: Consecutive newly diagnosed colorectal cancer patients who met the inclusion criteria were prospectively included in this single-center observational study. Preoperative 25-OH vitamin D levels were measured and analyzed for association with postoperative complications using univariable and multivariable logistic regression analyses.

Results: A total of 104 colorectal cancer patients were included in this study. Preoperative 25-OH vitamin D levels were found to be <10 ng/ml in 31 (29.8%) patients, 10-20 ng/ml in 42 (40.4%) patients, between 20-30 ng/ml in 25 (24%) patients and >30 ng/ml in 6 (5.8%) patients. In patients with infective complications, the mean value of 25-OH vitamin D levels were 12.33 (±6.306) ng/ml which was found to be statistically significant (p:0.026). In univariable logistic regression analyses, variables found to be associated with postoperative complications were age ≥ 65, male gender and preoperative 25-OH vitamin D levels, whereas in multivariable analyses, preoperative levels of 25-OH vitamin D were not found to be related with postoperative complications.

Conclusions: We demonstrated that vitamin D deficiency is a significant risk factor for development of infective complications and seems to be independently associated with postoperative complications in patients undergoing colorectal cancer surgery.

General Surgery

Surgery

Colorectal cancer

25-OH vitamin D

Postoperative complications

Infective complications

Colorectal cancer is the fourth most common cause of cancer-related mortality worldwide and radical resection is still the treatment of choice (1). Despite improvements in postoperative care, the rate of postoperative complication is changed between 19–30% in patients undergoing elective colorectal surgery (2). The most common known factors related with postoperative complications are nutritional status, comorbid diseases and timing of the operation (3–5). Inflammatory markers such as C-reactive protein (CRP), albumin and procalcitonin have been widely used in clinical practice for early detection of complications (6–9). As reported by numerous studies, postoperative complications have a great impact on not only short-term outcomes but also on overall survival in colorectal cancer patients (10–12).

25-hydroxy (OH) vitamin D levels have been found to be adversely related with colorectal cancer risk by causing adenoma formation in colon epithelium (13–16). 25-OH vitamin D levels have also been associated with long term survival and increased response to oncological treatment, however its effect on postoperative complications have not been thoroughly investigated (17, 18).

The aim of the present study was to evaluate the effect of serum 25-OH vitamin D levels on postoperative complications and short-term outcomes in colorectal cancer patients.

This study was designed as a prospective observational study which was approved by the Ethics Committee of Izmir Tepecik Training and Research Hospital, University of Health Sciences. All patients’ informed consents were obtained after oral and written explanations were made.

Patients’ selection

We performed this study in patients undergoing colorectal cancer surgery between September 2017 and March 2019 at the department of General Surgery, Izmir Tepecik Training and Research Hospital, University of Health Sciences. Consecutive patients who met the inclusion criteria were included in this study. The inclusion criteria were as follows; 1) histopathological evidence of colorectal cancer, 2) patients older than 18 years, 3) patients underwent curative resection. The exclusion criteria were as follows; 1) unresectable disease, 2) systemic metastases, 3) patients received neoadjuvant chemoradiotherapy, 4) patients underwent emergent operation or operated with palliative intent.

Data Collection

The routine preoperative work-up including complete blood count, liver and kidney function tests were done with an addition of preoperative serum levels of 25-OH vitamin D and carcinoembryogenic antigen (CEA). Patients’ nutritional status were evaluated using nutritional risk score-2002 (NRS) and comorbid diseases were classified according to American Society of Anesthesiologists (ASA)(19, 20). Postoperative complications occurring within 30 days of surgery were graded based on Clavien-Dindo scale (21). Pathology results were also recorded including histopathological grading and pathological tumor-node-metastasis (pTNM) staging (22).

Patients were divided into four vitamin D groups based on their preoperative 25-OH vitamin D levels as below 10 ng/ml (level of severe deficiency), between 10–20 ng/ml (level of mild deficiency), between 20–30 ng/ml (level of insufficiency) and above 30 ng/ml (normal level) according to Endocrine Society guidelines (23). Each vitamin D group was analyzed for development of postoperative complications (infective/non-infective) and also for the assessment of relation with Clavion-Dindo scale.

Study Objectives

The primary objective in our study was to demonstrate the effect of 25-OH vitamin D levels on postoperative complications, thus 30-day morbidity. The secondary objective was to evaluate its effect on histopathological grading and pTNM staging.

Statistical Analysis

The data was analyzed with IBM SPSS 21.0. Categorical and continuous variables were analyzed using chi-square test and student t-test. Pearson correlation test was used for analyzing the relation between laboratory parameters (albumin, hemoglobin, CEA) and 25-OH vitamin D levels. The potential risk factors for postoperative complications (gender, age, 25-OH vitamin D, hemoglobin, albumin, ASA and NRS scores, tumor location, histopathological grading and pTNM staging) were evaluated using univariable and multivariable logistic regression analysis. Variables with a p value < 0.2 in univariable logistic regression analyses were included in the multivariable logistic regression analyses and p value < 0.05 was accepted as significant for all analyses except univariable analysis.

104 patients (40 female, 64 male) who met the inclusion criteria were included in this study and the mean age was found to be 62.71 (± 12.41). The mean value of preoperative albumin, CEA and 25-OH vitamin D levels were 3.8 (± 0.5) gr/dl, 7.4 (± 11.6) µg/l and 15.95 (± 9.08) ng/ml, respectively. Patients’ demographic and clinical characteristics are shown in Table 1.

Tumor locations were demonstrated as colon in 74 patients (71.1%) and as rectum in 30 patients (28.8%)(Table 2). Metachronous colon tumor was found in 1 patient and synchronous colon tumors in 2 patients. Laparoscopic approach was chosen in 9 patients. The number of patients with postoperative complications were 25 (24%) and major complications (Clavien-Dindo scale 3–5) were seen in 10 patients (Table 3). Infective complications including wound infection, pneumonia, anastomotic leak and intra-abdominal abscess were observed in 18 patients (17.3%). Anastomotic leak occurred in 7 patients (6.73%), non-operative management was chosen in 2 patients and Hartmann procedure was performed in 5 patients.

Table 1

Patients demographic and clinical characteristics (n = 104)
Variables	N (%) or mean (± SD)
Age	62.71 (± 12.41)
Female/Male	40 (38.5%)/64 (61.5%)
ASA scores 1 2 3	17 (16.3%) 56 (53.8%) 31 (29.8%)
NRS scores 0 1 2 3	58 (55.8%) 31 (29.8%) 14 (13.5%) 1 (1%)
CEA (µg/l)	7.4 (± 11,6)
Albumin (gr/dl)	3.8 (± 0,5)
Hemoglobin (gr/l)	12.6 (± 1.99)
WBC (10^3/µl )	8080 (± 2274)
25-OH Vitamin D <10 ng/ml 10–20 ng/ml 20–30 ng/ml > 30 ng/ml	31 (29.8%) 42 (40.4%) 25 (24%) 6 (5.8%)
Abbreviations: SD, standard deviation; ASA, American Society of Anesthesiologists; NRS, Nutritional Risk Score-2002; CEA, carcinoembryogenic antigen; WBC, White blood cells

Table 2

Operative and pathological data (n = 104)
Variables	N (%) or mean (± SD)
Tumor location Colon Rectum	74 (71.1%) 30 (28.8%)
Operative Procedures Right Hemicolectomy Extended Right Hemicolectomy Left Hemicolectomy Extended Left Hemicolectomy Anterior Resection Low Anterior Resection Abdominoperineal Resection Total Colectomy	20 (19.2%) 5 (4.8%) 6 (5.7%) 8 (7.6%) 14 (13.4%) 39 (37.5%) 6 (5.7%) 6 (5.7%)
pTNM Staging 1 2 3 4	19 (18.3%) 45 (43.3%) 38 (36.5%) 1(1%)
Histopathological Results Carcinoma in-situ Adenocarcinoma Mucinous Adenocarcinoma Signet Cell Carcinoma Malignant Fibrous Histiocytoma	2 88 12 1 1
Pathological Grading G1 G2 G3	22 74 5
Abbreviations: SD, standard deviation; pTNM, pathological tumor-node-metastasis

Table 3

Short-term outcomes (n = 104)
Variables	N (%) or median (min-max)
Number of patients with complications	25 (24%)
Infective Complications Wound Infection Anastomotic Leak Intra-abdominal abscess Pneumonia Non-infective Complications Wound Dehiscence Postoperative Ileus Pneumothorax Myocardial Infarction Arrhythmia	9 (8.6%) 7 (6.73%) 1 (0.96%) 4 (3.84%) 3 (2.88%) 3 (2.88%) 1 (0.96%) 1 (0.96%) 1 (0.96%)
Clavien-Dindo Scale 0 1–2 3–4 5	79 (75.9%) 15 (14.4%) 8 (7.69%) 2 (1.92%)
Length of Hospital Stay	7 (3–29)
30-day mortality	2 (1.92%)

The mean value of preoperative 25-OH vitamin D levels were 13.11 (± 6.18) and 16.83 (± 9.68) ng/ml in patients with and without complications, respectively (p:0.07). Preoperative 25-OH vitamin D levels were found to be < 10 ng/ml in 31 (29.8%) patients, 10–20 ng/ml in 42 (40.4%) patients, between 20–30 ng/ml in 25 (24%) patients and > 30 ng/ml in 6 (5.8%) patients. In patients with infective complications, the mean value of 25-OH vitamin D levels were 12.33 (± 6.306) ng/ml which was found to be statistically significant (p:0.026). Whereas, there was no significant difference observed for development of infective or postoperative complications between vitamin D groups.

Preoperative levels of 25-OH vitamin D were not found to be related with NRS scores, pathological grading and pTNM staging. Also, there was no correlation detected between 25-OH vitamin D levels and hemoglobin, albumin and CEA levels.

Obtained data were changed to categorical variables (age ≥ 65, ASA ≥ 3, albumin ≥ 3.4 gr/ dl, hemoglobin ≥ 10 gr/dl, NRS ≥ 2) in order to perform logistic regression analyses (Table 4). In univariable logistic regression analyses, variables found to be associated with postoperative complications were age ≥ 65, male gender and preoperative 25-OH vitamin D levels (p:0.041, p:0.024, p:0.138). However, in multivariable analyses, preoperative levels of 25-OH vitamin D were not found to be related with postoperative complications. Moreover, there was no association found between Clavien-Dindo scale and preoperative 25-OH vitamin D levels.

Table 4

Logistic regression analyses of potential risk factors related with postoperative complications
	Univariable		Multivariable
Variables	HR (%95 CI)	p value	HR (%95 CI)	p value
Age ≥ 65	3.78(1.05–13.49)	0.041*	3.26(1.21–8.76)	0.019**
Male gender	4.48(1.21–16.49)	0.024*	0.26(0.083–0.81)	0.02**
ASA ≥ 3	0.72(0.19–2.70)	0.63	-	-
Albumin ≥ 3.4 gr/ dl	1.94(0.45–8.23)	0.36	-	-
Hemoglobin ≥ 10 gr/dl	0.28(0.02–2.92)	0.29	-	-
NRS ≥ 2	0.81(0.17–3.74)	0.79	-	-
Colon/Rectum	0.71(0.20–2.50)	0.59	-	-
25-OH vitamin D	0.94(0.87–1.01)	0.138*	1.06(0.99–1.14)	0.091
Pathological grading	1.78(0.55–5.78)	0.33	-	-
pTNM staging	1.18(0.55–2.53)	0.66	-	-
Abbreviations: HR, Hazard ratio; CI, confidential interval; ASA, American Society of Anesthesiologists; NRS, Nutritional Risk Score-2002; pTNM, pathological tumor-node-metastasis
*Level of significance was accepted as p < 0.2 in univariable analyses
**Level of significance was accepted as p < 0.05 in multivariable analyses

In present study, we found significantly decreased preoperative 25-OH vitamin D levels in patients with infective complications. Also we observed that preoperative levels of 25-OH vitamin D were one of the potential risk factors for development of postoperative complications in patients undergoing colorectal cancer surgery.

In recent years, there has been an increasing number of studies investigating the effect of 25-OH vitamin D on progression-free survival and overall survival in patients with colorectal cancer (24–26). It has been also revealed that infective complications are increased in hospitalized patients with vitamin D deficiency because of its decreased immunomodulatory effects (27, 28). As reported by previous studies, preoperative 25-OH vitamin D levels were found to be adversely related with surgical site infections in patients undergoing cardiac surgery and total knee arthroplasty (29, 30). Quraishi et. al have also reported that hospital acquired infections are associated with preoperative 25-OH vitamin D levels in patients following bariatric surgery (31).

In order to assess the effect of 25-OH vitamin D levels on postoperative complications better, we excluded the patients operated in emergency settings and patients received neoadjuvant chemoradiotherapy. As a result, our sample size was reduced to 104 patients with a mean 25-OH vitamin D value of 15.95 (± 9.08) ng/ml which corresponds to vitamin D deficiency. Similar to previous studies we observed a significant association between preoperative 25-OH vitamin D levels and infective complications. Laviano et. al revealed that preoperative 25-OH vitamin D levels were not only related with development of hospital acquired infections but also with Clavien-Dindo scale of postoperative complications (32). In contrast to their results, we observed no association between Clavien-Dindo scale and 25-OH vitamin D levels in our study.

In a recent study conducted in patients undergoing varied types of gastrointestinal tract, hepatobiliary, thoracic, and vascular operations, preoperative 25-OH vitamin D levels were found to be independent predictors of surgical site infections in addition to ASA scores, albumin and hemoglobin levels (33). However, we did not find any relation between postoperative complications and ASA scores, albumin and hemoglobin levels.

Our secondary objective was to evaluate the effect of 25-OH vitamin D levels on histopathological grading and pTNM staging based on the fact that decreased 25-OH vitamin D levels are linked with poorer survival in colorectal cancer patients (34). However we found no association of 25-OH vitamin D levels with pathological grading and pTNM staging in our study. Whereas Värynen et. al revealed that 25-OH vitamin D levels were lower in pTNM stage 2–4 colorectal cancer patients compared to pTNM stage 1 colorectal cancer patients (16).

The major limitation of our study was the small sample size with a significantly high prevalence of vitamin D deficiency (94%) which causes heterogeneous vitamin D groups in terms of number of patients. Therefore, we could not draw firm results for associations between vitamin D groups and postoperative complications or Clavien-Dindo scale. Furthermore, dose-response analysis of vitamin D levels for infective complications could not be performed in this study.

To our knowledge, this is the first study investigating the effect of 25-OH vitamin D levels on infective and overall postoperative complications in patients undergoing colorectal cancer surgery. As a result, vitamin D deficiency is a significant risk factor for development of infective complications and seems to be independently associated with postoperative complications. Considering recent studies and our study, we suggest that serum 25-OH vitamin D levels should be measured preoperatively for all patients undergoing elective surgery and vitamin D supplementation should be given in a preoperative setting in order to improve short-term outcomes.

Ethics approval and consent to participate: This study was designed as a prospective observational study which was approved by the Ethics Committee of Izmir Tepecik Training and Research Hospital, University of Health Sciences. All patients’ informed consents were obtained after oral and written explanations were made. All methods in present study were carried out in accordance with relevant guidelines and regulations.

Consent for publication: Not applicable

Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests: The authors declare that they have no competing interests.

Funding: Not applicable

Authors' contributions: BB contributed to investigation, data collection, formal analysis and writing the original draft. OC contributed to methodology, formal analysis, writing-review and editing. GK contributed to investigation and data collection. BC contributed to methodology, review and editing. CA contributed to methodology, review and editing, supervision.

Acknowledgements: Not applicable

1- Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017 Apr;66(4):683-691.

2- Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery; a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667-678.

3- Schiesser M, Kirchhoff P, Müller MK, Schäfer M, Clavien PA. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery. 2009 May;145(5):519-26.

4- Hendry PO, Hausel J, Nygren J, Lassen K, Dejong CH, Ljungqvist O, Fearon KC; Enhanced Recovery After Surgery Study Group. Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg. 2009 Feb;96(2):197-205.

5- Lee, C.H.A., Kong, J.C.H., Heriot, A.G. et al. Short-term outcome of emergency colorectal cancer surgery: results from Bi-National Colorectal Cancer Audit. Int J Colorectal Dis 34, 63–69 (2019). https://doi.org/10.1007/s00384-018-3169-5

6- McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015 Apr;102(5):462-79.

7- McSorley ST, Khor BY, MacKay GJ, Horgan PG, McMillan DC. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study. Medicine (Baltimore). 2017 Feb;96(7):e6133.

8- Montomoli J, Erichsen R, Antonsen S, et al. Impact of preoperative serum albumin on 30-day mortality following surgery for colorectal cancer: a population-based cohort study. BMJ Open Gastroenterol 2015;2:e000047

9- Domínguez-Comesaña E, Estevez-Fernández SM, López-Gómez V, Ballinas-Miranda J, Domínguez-Fernández R. Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer. Int J Colorectal Dis. 2017 Dec;32(12):1771-1774.

10- McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2016 Jan;97:168-77.

11- Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015 Mar;261(3):497-505.

12- Odermatt M, Miskovic D, Flashman K, Khan J, Senapati A, O'Leary D, Thompson M, Parvaiz A. Major postoperative complications following elective resection for colorectal cancer decrease long-term survival but not the time to recurrence. Colorectal Dis. 2015 Feb;17(2):141-9.

13- McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, Eliassen AH, Zeleniuch-Jacquotte A, Agnoli C, Albanes D, Barnett MJ, Buring JE, Campbell PT, Clendenen TV, Freedman ND, Gapstur SM, Giovannucci EL, Goodman GG, Haiman CA, Ho GYF, Horst RL, Hou T,Huang WY, Jenab M, Jones ME, Joshu CE, Krogh V, Lee IM, Lee JE, Männistö S, Le Marchand L, Mondul AM, Neuhouser ML, Platz EA, Purdue MP, Riboli E, Robsahm TE, Rohan TE, Sasazuki S, Schoemaker MJ, Sieri S, Stampfer MJ, Swerdlow AJ, Thomson CA, Tretli S, Tsugane S, Ursin G, Visvanathan K, White KK, Wu K, Yaun SS, Zhang X, Willett WC, Gail MH, Ziegler RG, Smith-Warner SA. Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts. J Natl Cancer Inst. 2018 Jun 14. doi: 10.1093/jnci/djy087

14- Dimitrakopoulou VI, Tsilidis KK, Haycock PC, et al. Circulating vitamin D concentration and risk of seven cancers: Mendelian randomisation study. The BMJ. 2017;359:j4761.

15- Gibbs DC, Fedirko V, Um C, Gross MD, Thyagarajan B, Bostick RM. Associations of Circulating 25-Hydroxyvitamin D3 Concentrations With Incident, Sporadic Colorectal Adenoma Risk According to Common Vitamin D Binding Protein Isoforms. Am J Epidemiol. 2018 May 21.

16- Väyrynen JP^1,2, Mutt SJ³, Herzig KH^2,3,4, Väyrynen SA^1,2, Kantola T^1,2, Karhu T³, Karttunen TJ^1,2, Klintrup K^2,5, Mäkelä J^2,5, Mäkinen MJ^1,2, Tuomisto A^1,2. Decreased preoperative serum 25-Hydroxyvitamin D levels in colorectal cancer are associated with systemic inflammation and serrated morphology. Sci Rep. 2016 Nov 7;6:36519.

17- Maalmi H, Walter V, Jansen L, Boakye D, Schöttker B, Hoffmeister M, Brenner H. Association between Blood 25-Hydroxyvitamin D Levels and Survival in Colorectal Cancer Patients: An Updated Systematic Review and Meta-Analysis. Nutrients. 2018 Jul 13;10(7).

18- Yang L, Chen H, Zhao M, Peng P. Prognostic value of circulating vitamin D binding protein, total, free and bioavailable 25-hydroxy vitamin D in patients with colorectal cancer. Oncotarget. 2017;8(25):40214-40221.

19- Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003 Jun;22(3):321-36. doi: 10.1016/s0261-5614(02)00214-5. PMID: 12765673.

20- Hurwitz EE, Simon M, Vinta SR, et al. Adding examples to the ASA-Physical Status classification improves correct assignments to patients. Anesthesiology 2017; 126:614-22

21- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13

22- Edge, S.B., Compton, C.C., 2010. The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Annals of Surgical Oncology.. doi:10.1245/s10434-010-0985-4

23- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–1930.

24- Maalmi H, Ordonez-Mena JM, Schottker B, Brenner H. Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: systematic review and meta-analysis of prospective cohort studies. Eur J Cancer. 2014;50(8):1510–21

25- Abrahamsson H, Porojnicu AC, Lindstrøm JC, Dueland S, Flatmark K, Hole KH, et al. High level of circulating vitamin D during neoadjuvant therapy may lower risk of metastatic progression in high-risk rectal cancer. BMC Cancer. 2019 May 23;19(1):488. doi: 10.1186/s12885-019-5724-z.

26- Ng K, Nimeiri HS, McCleary NJ, Abrams TA, Yurgelun MB, Cleary JM, et al. Effect of High-Dose vs Standard-Dose Vitamin D3 Supplementation on Progression-Free Survival Among Patients With Advanced or Metastatic Colorectal Cancer: The SUNSHINE Randomized Clinical Trial. JAMA. 2019 Apr 9; 321(14):1370-1379.

27- Toubi E, Shoenfeld Y. The role of vitamin D in regulating immune responses. Isr Med Assoc J 2010; 12:174 - 5; PMID: 20684184

28- Youssef DA, Ranasinghe T, Grant WB, Peiris AN. Vitamin D’s potential to reduce the risk of hospital-acquired infections. Derm Endocrinol. 2012;4:167e175

29- Zittermann A, Kuhn J, Ernst JB, Becker T, Larisch J, Dreier J, et al. Circulating 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Concentrations and Postoperative Infections in Cardiac Surgical Patients: The CALCITOP-Study. PLoS One. 2016 Jun 29;11(6):e0158532. doi: 10.1371/journal.pone.0158532. eCollection 2016.

30- Hegde V, Arshi A, Wang C, Buser Z, Wang JC, Jensen AR, et al. Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complication Rates in Total Knee Arthroplasty. Orthopedics. 2018 Jul 1;41(4):e489-e495. doi: 10.3928/01477447-20180424-04. Epub 2018 Apr 30.

31- Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA Jr. Association between preoperative 25-hydroxyvitamin D level and hospital-acquired infections following Roux-en-Y gastric bypass surgery. JAMA Surg. 2014 Feb;149(2):112-8. doi: 10.1001/jamasurg.2013.3176.

32- Laviano E, Sanchez Rubio M, González-Nicolás MT, Palacian MP, López J, et al. (2020) Association between preoperative levels of 25-hydroxyvitamin D and hospital-acquired infections after hepatobiliary surgery: A prospective study in a third-level hospital. PLOS ONE 15(3): e0230336. https://doi.org/10.1371/journal.pone.0230336

33- Abdehgah AG, Monshizadeh A, Tehrani MM, Afhami S, Molavi B, Jafari M, Nasiri S, Soroush A. Relationship Between Preoperative 25-Hydroxy Vitamin D and Surgical Site Infection. J Surg Res. 2020 Jan;245:338-343. doi: 10.1016/j.jss.2019.07.036. Epub 2019 Aug 16. PMID: 31425873.

34- Wu G, Xue M, Zhao Y, Han Y, Zhang S, Zhang J, Li C, Xu J. Low circulating 25-hydroxyvitamin D level is associated with increased colorectal cancer mortality: a systematic review and dose-response meta-analysis. Biosci Rep. 2020 Jul 31;40(7):BSR20201008. doi: 10.1042/BSR20201008. PMID: 32686830; PMCID: PMC7391129.

Download PDF

Version 1

posted

You are reading this latest preprint version

The relation of preoperative 25-OH Vitamin D Levels with Postoperative Complications in Patients undergoing Colorectal Cancer Surgery

Status:

Version 1

Abstract

Background

Methods

Results

Discussion

Conclusions

Declarations

References

Status:

Version 1