Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study

Abstract

A c c e p t e d A r t i c l e ABSTRACT Purpose: The treatment of acutely obstructing colorectal cancers is still a matter of debate.The prevailing opinion is that an immediate resection should be performed whenever possible.This study sought to determine whether immediate resection is safe (1) and oncologically valid (2). Methods:We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble's Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest.Results: Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. Conclusion:Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.

Failure to rescue after reoperation for major complications of elective and emergency colorectal surgery: A population-based multicenter cohort study

“…29 The reoperation rate after emergency colorectal resection in our study was 10.4%, which also compared favorably to rates in earlier publications with reported rates of 7.0% to 14.3%. 7,27,30 The overall FTR rate of 17.4% in our series could also be compared to reported figures. A nationwide Dutch cohort, including FTR after any complications, reported FTR rates ranging from 14% to 17%; a Swedish nationwide cohort had 10% FTR rate for severe complications with a Clavien-Dindo score of !3; and a UK cohort had rates between 11% and 17% after reoperation, all depending on the hospital status.…”

Surgical safety in the COVID-19 era: present and future considerations

“…These reports included positive COVID-19 cases. Although COVID-19 again showed a significant association with postoperative morbidity and mortality [ 26 ], the majority of noninfected patients could be treated successfully with stringent mitigation protocols in place, and the outcomes, including adverse events, were comparable to those found in the pre-pandemic period [ 41 ]. The postoperative COVID-19 infection rate was reported to be around 3% [ 24 ].…”

Is Low Inferior Mesenteric Artery Ligation Worthwhile to Prevent Urinary and Sexual Dysfunction After Total Mesorectal Excision for Rectal Cancer?

“…In our study, we aimed to investigate the role of high and low IMA ligation and no other confounding factors (i.e. radiation therapy, neoadjuvant chemotherapy and open surgery, benign lesions, emergency setting) (9,(31)(32)(33)(34)(35) in the impairment of the defecatory, sexual and urinary function after TME. The ligation of the IMA at its origin may accidentally damage the superior hypogastric plexus, which is interconnected with the inferior hypogastric plexus.…”