Urgent surgery in colon cancer has no impact on survival

Abstract

Background and objectives Despite advances in early detection of colon cancer, a minority of patients still require urgent surgery. Whether such urgent conditions result in poor outcome remains a topic of debate. Methods Using a prospectively maintained database, patients suffering exclusively from colon cancer and receiving either elective or emergent resection between 2001 and 2014 were analyzed with respect to overall, disease‐specific, and relative survival using Cox regression and propensity score analyses. Results From a total of 877 patients analyzed, 2.7% (24) presented with complications requiring urgent surgery. Propensity‐scoring identified strongly biased patient characteristics (0.097 ± 0.069 vs 0.028 ± 0.043; P < 0.001). An unadjusted Cox proportional hazards regression analysis revealed urgent surgery as a statistically significant prognostic factor with an approximately 207% increased risk of mortality (hazard ratio [HR] = 3.07; 95% confidence interval [CI]: 1.62‐5.81; P = 0.003). After adjusting the data according to the propensity score analysis, urgent surgery was not associated with a decreased overall (HR = 1.67; 95%CI; 0.84‐3.36; P = 0.174), disease‐specific (HR = 1.62; 95% CI; 0.81‐3.24; P = 0.201) or relative survival (HR = 1.86; 95% CI: 0.92‐3.79; P = 0.086). Conclusions After risk‐adjustment, using multivariable Cox regression and propensity score analyses, no significant disadvantage could be noted with regard to overall, disease‐specific, or relative survival in patients with exclusively colon cancer who received emergent oncological resection.

Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy

“…In support, the scientific community did not achieve consensus as well. Antony et al have concluded after risk adjustment that urgent surgery in colon cancer has no impact on survival [ 52 ]. On the other hand, Ramos et al claimed that there was a high mortality rate and a low survival rate in colorectal cancer patients operated on urgently [ 53 ].…”

Serum bicarbonate is a marker of peri-operative mortality but is not associated with long term survival in colorectal cancer

“…Indeed, when we adjusted for many of these factors, serum bicarbonate remained significantly prognostic. Moreover, there is evidence in the literature to suggest that urgent operations in colorectal cancer when adjusted for other risk factors appropriately is not in itself associated with differences in overall survival or disease free survival [21,22]. Another limitation was that the current study lacked complete information on co-morbidities or medications that could confound the current results.…”

Stoma-less IPAA Is Not Associated With Increased Anastomotic Leak Rate or Long-term Pouch Failure in Patients With Ulcerative Colitis

“…Table 1 demonstrates demographic and perioperative details comparing those who had a stoma-less IPAA construction to those who had a DLI at the time of IPAA. There was no significant difference between the 2 groups in terms of sex, age, preoperative biologic usage, case status (elective vs urgent), 15 and surgical approach (open vs laparoscopic) of IPAA creation ( p > 0.05). There was a higher percentage of smokers in the stoma-less IPAA group (11% vs 4.6%) compared to the ileostomy group ( p < 0.001).…”