Evaluation of the patients with colorectal cancer undergoing emergent curative surgery

Abstract

BackgroundThe aim of our study is to evaluate perioperative and mid-term oncologic outcomes of the patients with colorectal cancer, who underwent emergent curative surgery.MethodsThe study included all patients with colorectal cancer, who underwent surgery for curative intent between 1 January 2012 and 31 December 2014 in General Surgery Department of Kartal Training and Research Hospital. The patients were divided into two groups according to the type of admission (emergent or elective). The data of the patients were retrospectively collected with chart review. Demographic characteristics of the patients, ASA scores, emergent indications and surgical interventions, postoperative complications, pathological findings, oncological therapy, and follow-up findings were investigated.ResultsFifty-one and 209 patients were evaluated in both groups, respectively. Rate of right sided and sigmoid/recto-sigmoid tumors were significantly higher in emergent group. Ostomy rate, early morbidity, ICU need, transfusion, and mortality rates in emergent group were significantly higher than elective group. Average length of hospital stay in emergent group was also significantly longer in elective group (11.2 ± 3.2 vs. 8.4 ± 2.4 days). The patients in emergent group had a much lower survival rate than those in elective group.ConclusionIn our study, emergency presentation of colorectal cancer was found associated with increased morbidity, a longer length of stay, increased in-hospital mortality, advanced pathologic stage and worsened long term survival in even same stages.

Urgent surgery in colon cancer has no impact on survival

“…Indeed, other authors have reported more conflicting results. For example, Kundes et al found that emergency presentation was associated with poor long term survival, even in patients presenting with the same disease stage. Similarly, Oliphant et al reported that the 5‐year relative survival was 91.8% after elective and 66.8% after emergency presentation ( P < 0.001) and the adjusted relative excess risk ratio for 5‐year relative survival after emergency relative to elective presentation was 2.59 (95% CI: 1.67‐4.01; P < 0.001) and 1.90 (95% CI: 1.00‐3.62; P = 0.049) after exclusion of postoperative deaths.…”

“…However, both studies included patients with colon and rectum cancer and only performed a limited adjustment for differences between the groups. Whereas Kundes et al adjusted only for tumor stage, Oliphant et al adjusted only for patient age using the relative survival approach. In contrast, and more in keeping with our results, Coco et al conducted a study of 787 patients where 50 emergency patients were matched for age, tumor location, tumor stage, and comorbidities with 50 nonemergency case controls and found that the in‐hospital and long term survival rates were similar between the two groups.…”

“…However, a minority of patients still present with emergent complications, including bowel obstruction or worse, perforation requiring immediate intervention . Such emergent intervention is often associated with greater risk, as assessed by morbidity (40‐50%) and mortality (15‐20%) . Furthermore, it has been postulated that emergent presentation may lead to increased rates of local recurrence as well as the poor oncological outcome .…”

“…Such emergent intervention is often associated with greater risk, as assessed by morbidity (40‐50%) and mortality (15‐20%) . Furthermore, it has been postulated that emergent presentation may lead to increased rates of local recurrence as well as the poor oncological outcome . Some authors have attributed these undesirable outcomes to disparities in patient age, comorbidities, malnutrition, and advanced tumor stage .…”

“…However, the extent to which such factors may influence the oncological outcome, if any, is unclear. To date, most studies have included patients with both colon and rectum cancer, further distorting the observed outcome as both tumor entities should be investigated separately due to differences in anatomy, clinical behavior, and stage‐dependent treatment. Therefore, when including rectal cancer, it is of utmost importance to adjust for clinically relevant factors, such as quality of mesorectal resection and circumferential resection margin status, both of which are known to impact survival and local recurrence rates .…”