An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients

Abstract

Objective: Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. Material and Methods:Files of colorectal patients treated between 2009-2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared.Results: There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. Conclusion:Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results. INTRODUCTIONColorectal cancer (CRC) is one of the most frequent cancers with more than one million people worldwide being diagnosed with CRC annually, which is the most common gastrointestinal tract cancer (1). The majority of these neoplasms are endoluminal adenocarcinoma derived from the mucosa, and over 95% of CRC patients benefit from surgery or colonoscopic interventions for premalignant polyps with early diagnosis (2). Despite advances in diagnosis and treatment and dissemination of communitybased screening, colorectal cancer remains to be one of the main reasons of cancer-related deaths in the world (3).

Surgical site infection among patients after colorectal cancer surgery

“…The difference was even greater in patients with both comorbidities. SSI was twice as frequent in this group (24.32% vs. 11.94%, p=0.002) ( [28].…”

Predictive Factors for the Development of Surgical Site Infection After Colorectal Cancer Surgery

“…; kolorektal kanser cerrahisinin acil şartlarda gerçekleştirildiği hastalarda postoperatif CAE gelişiminin daha yüksek olduğunu ve bunun da istatistiksel olarak anlamlı olduğunu belirtmişlerdir. 60 Aciliyet ile enfeksiyon arasındaki ilişki incelendiğinde; enfeksiyon olmayanların %12,3'ü acil, enfeksiyon olanların ise %76,2'si acildir. Dolayısıyla acil şartlarda gerçekleştirilmiş kolorektal cerrahilerden sonra gözlenen enfeksiyon oranlar arasında anlamlı düzey ilişki bulunmaktadır (p<0,05).…”

Future Perspectives of ERAS: A Narrative Review on the New Applications of an Established Approach

“…The setting of emergency obviously limits compliance with the entire protocol, since this was initially designed for elective situations. Moreover, emergency patients might be considered at higher risk [ 16 ]. However, the potential benefits of those evidence-based protocols should not be denied to patients undergoing urgent surgery [ 17 ].…”