Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes

Amri, Ramzi; Bordeianou, Liliana; Sylla, Patricia; Berger, David L.

doi:10.1016/j.amjsurg.2014.07.014

Cited by 44 publications

(44 citation statements)

References 29 publications

(26 reference statements)

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“…1,11,23 This is in part driven by the knowledge that patients with colorectal cancer have worse oncologic outcomes with emergency operations and the fact that survival after an emergent procedure in this population is shorter. 15,24,25 In contrast, our results indicate that survival in patients with unplanned surgeries actually survive longer than patients who undergo no surgery at all. This should be interpreted with caution given inherent selection bias in our retrospective study design.…”

Section: Resultscontrasting

confidence: 73%

“…These include obstruction, uncontrollable bleeding, or perforation all of which require an unplanned intervention under less favorable circumstances . This is in part driven by the knowledge that patients with colorectal cancer have worse oncologic outcomes with emergency operations and the fact that survival after an emergent procedure in this population is shorter . In contrast, our results indicate that survival in patients with unplanned surgeries actually survive longer than patients who undergo no surgery at all.…”

Section: Discussionmentioning

confidence: 74%

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Frequency of unplanned surgery in patients with stage IV colorectal cancer receiving palliative chemotherapy with an intact primary: An analysis of SEER‐Medicare

Lorimer

Motz

Kirks

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Stage IV colorectal cancer is often treated with palliative chemotherapy with the primary tumor in place. Low rates of unplanned surgical intervention (due to obstruction or perforation) have been reported. We examined a large national dataset to determine the rate of unplanned surgical intervention in these patients. Methods Surveillance Epidemiology and End Results‐Medicare were queried for patients with metastatic colorectal cancer receiving chemotherapy (1998‐2013). Patient who underwent planned surgery to the primary or metastasectomy were excluded. The primary outcome was the need for nonelective surgery. Time to surgery or death was measured. Conditional analyses were performed to determine the risk of surgical intervention at 6‐month, 1‐, and 2‐year after diagnosis. Results The analytic cohort consisted of 4692 patients (median age = 75). At 24 months, 80% of the patients had died. The overall unplanned intervention rate was 12%. The probability of requiring unplanned surgery between 6 and 12 months was 8.1%; 12 and 24 months = 6.7%, and >24 months = 5.3%. Males, those with right‐sided tumors, and older patients were less likely to require surgery. Conclusions Patients treated with palliative chemotherapy who are not resected upfront are unlikely to require unplanned surgery. Prophylactic surgery to reduce the risk of perforation or obstruction may not be necessary.

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Section: Resultscontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 74%

Frequency of unplanned surgery in patients with stage IV colorectal cancer receiving palliative chemotherapy with an intact primary: An analysis of SEER‐Medicare

Lorimer

Motz

Kirks

et al. 2019

Journal of Surgical Oncology

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“…In our study, emergency CRC patients had higher ostomy rate than elective CRC patients. Recent studies examined post-operative mortality are worse in emergency CRC surgery group than elective CRC surgery one (25,26). Our early postoperative mortality rate (11.5%) is comparable with previous studies mortality ranging from 5.7 to 15.3% ( 25,27,28,29).…”

Section: Discussionsupporting

confidence: 77%

The results of emergent curative surgery for the colorectal cancer; a single center experience of 52 patients

Öter¹,

Yalçın²,

Oter³

2018

J Turgut Ozal Med Cent

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Aim: Even though, protective methods and early diagnostic modalities are used in current practice, almost 6 to 30% of colorectal cancer patients admit to hospital for emergency operation with late complications. The aim of this study is to interpreting data of the early postoperative oncologic outcomes of the emergent curative CRC surgeries. Material and Methods: Between January 2012 and January 2017, 173 patients were operated curatively for colorectal cancer at Mehmet Akif İnan Training and Research Hospital of Health Sciences University. Of these, 52 patients were treated with emergent curative colorectal surgery. Demographics, laboratory, and clinical data, diagnostic studies, surgical procedures, operative findings, histopathologic results, postoperative complications, and patient follow-up were retrospectively analyzed. Results: The mean age (59.6 ± 10.9 vs. 57.7 ± 11.5, P = 0.98) and gender (71.15 vs. 76.03% male, P = 0.18) were close in emergent and elective colorectal cancer surgery groups. Early postoperative mortality was seen in 6 (11.5%) of those patients. The mean postoperative hospital stay in emergent surgery group was significantly longer than in elective surgery group. The 2-years overall survival rate of emergent and elective group were estimated 33 versus 77%, respectively. Conclusion: Our findings reveal that emergency CRC surgery predicts more advanced disease and longer operation time. Also in the emergent group have a higher complication rates, longer hospital stay, increased early postoperative morbidity, and lower long term survival in even all same stages.

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“…A Swedish study found that colon cancer patients with a lower level of education, or lower income, were more likely to present as emergencies and, in analyses of a subgroup of colon cancers in Ireland, 31% of current smokers presented as emergencies compared to 24% of ex‐smokers and never smokers combined. Since cases which present as emergencies have higher mortality, this suggests that a higher frequency of emergency presentation among smokers could help explain the observed association. Positive margins are a risk factor for recurrence following resection for colon cancer and a single study has reported a slightly higher rate of radial margin positivity among current smokers (6.4%) than other colon cancer patients (5.1%) .…”

Section: Discussionmentioning

confidence: 92%

Smoking at diagnosis significantly decreases 5‐year cancer‐specific survival in a population‐based cohort of 18 166 colon cancer patients

Sharp

McDevitt

Brown

et al. 2017

Aliment Pharmacol Ther

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Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes

Cited by 44 publications

References 29 publications

Frequency of unplanned surgery in patients with stage IV colorectal cancer receiving palliative chemotherapy with an intact primary: An analysis of SEER‐Medicare

Frequency of unplanned surgery in patients with stage IV colorectal cancer receiving palliative chemotherapy with an intact primary: An analysis of SEER‐Medicare

The results of emergent curative surgery for the colorectal cancer; a single center experience of 52 patients

Smoking at diagnosis significantly decreases 5‐year cancer‐specific survival in a population‐based cohort of 18 166 colon cancer patients

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