PURPOSE: Colorectal cancer commonly presents first as an emergency and is likely to be complicated by bowel obstruction/perforation requiring more difficult procedures, with poorer outcomes. Analysis of all of the procedures performed on patients diagnosed in Wexford General Hospital, Ireland, during the period 2000 to 2006 was carried out to validate this hypothesis in our western European population.METHODS: Retrospective analysis of a prospectively maintained database of patient demographics, diagnosis, procedures, and mode of presentation (elective, emergency) was undertaken. RESULTS: A total of 356 patients with colorectal cancer underwent 498 procedures during the years 2000 to 2006.Eighty-four emergency endoscopies and 100 emergency bowel resections were performed. Obstructive lesions were more likely to require emergency resection (P G 0.001). Median survival time for patients treated electively was 82 months vs. 59 months for patients treated on an emergency basis.CONCLUSIONS: Of all colonic resections, 34 percent were carried out as emergencies and were significantly more likely to be complicated by obstruction or perforation (P G 0.001). Emergency resections were associated with a significantly poorer perioperative mortality and five-year survival rate (P G 0.001). Forty-one percent of colorectal cancers diagnosed at endoscopy were first seen emergently. These data raise concerns regarding public awareness of colorectal cancer and resource allocation and reemphasize the need for a national colorectal screening program.
Introduction
Textbook outcomes (TBO) are composite measures of care which may be superior in assessing quality compared to traditional methods. We aim to define TBO which are specific to surgical resection of colorectal liver metastases, and investigate their impact on survival.
Methods
Single center analysis of all liver resections performed at our center from 2009 to 2020. A Cox model was used to identify perioperative outcomes which impacted on overall survival. These were retained with important postoperative outcomes to form a “TBO.” The impact of a TBO on overall survival was investigated using Kaplan−Meier curve analysis.
Results
TBO was achieved in 72.2% (197/273) of resections. Major morbidity (Clavien−Dindo ≥3) at 19.4% was the major limiting factor in not achieving a TBO. TBO was associated with improved 3‐year (77% vs. 55%), 5‐year (60.7% vs. 42.5%), and median (93 vs. 44 months) overall survival (log‐rank test, p = 0.006). Multivariable analysis revealed age >65 years, American Society of Anaesthesiologists Grade III–IV, and resection of >2 segments as factors predictive of not achieving a TBO.
Conclusion
TBO is a useful composite measure in surgery for colorectal liver metastases. It can highlight areas which may be targeted for quality improvement and be useful as a tool to examine variation between centers. Achieving a TBO is associated with a significant improvement in survival.
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