title: Volume of blood loss during surgery for colon cancer is a risk determinant for future small bowel obstruction caused by recurrence--a population-based epidemiological study.
abstract: OBJECTIVE
  Small bowel obstruction (SBO) is a serious late complication after abdominal surgery. The pathogenesis of intra-abdominal adhesions has been extensively studied and reviewed, but the cascade of mechanisms involved is still not understood. The objective was to test the hypothesis that increasing volume of blood loss during surgery for colon cancer increases the risk for future SBO, mainly due to adhesions.
  
  
  METHODS
  Data were retrieved from the Regional Quality Register for all patients undergoing locally radical surgery for colon cancer 1997-2003 (n = 3 554) and matched with the Swedish National Patient Register data on surgery and admission for SBO. Records were reviewed to determine the etiology of surgery for SBO. Uni- and multivariate Cox analyses were used.
  
  
  RESULTS
  One hundred ten patients (3.1 %) underwent surgery for SBO >30 days after the index operation. Blood loss ≥250 ml was an independent risk factor for surgery for SBO due to recurrence (HR 2.20; 95 % CI 1.12-4.31). Amount of blood loss did not affect the risk for surgery for SBO due to adhesions. Furthermore, blood loss of ≥250 ml increased the risk for hospital admission for SBO not requiring surgery.
  
  
  CONCLUSIONS
  Blood loss ≥250 ml during surgery for colon cancer is an independent risk factor for later surgery for SBO caused by tumor recurrence, not by adhesions.
authors.affiliation: Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden, malin.morner@ki.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Mörner
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Pia
authors.initials: P
authors.lastname: Jestin
authors.forename: Monika
authors.initials: M
authors.lastname: Egenvall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002648:Child; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D000267:Tissue Adhesions / Q000150:complications*