Emergency surgery for complicated colorectal cancer in central Brazil

Abstract

Objective to report clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery. Methods records of 107 patients operated between 2006 and 2010 were reviewed. Results there were 58 women and 49 men with mean age of 59.8 years. The most frequent symptoms were: abdominal pain (97.2%), no bowel movements (81.3%), vomiting (76.6%), and anorexia (40.2%). Patients were divided into five groups: obstructive acute abdomen (n = 68), obstructive acute perforation (n = 21), obstructive acute inflammation (n = 13), abdominal sepsis (n = 3), and severe gastrointestinal bleeding (n = 2). Tumors were located in the rectosigmoid (51.4%), transverse colon (19.6%), ascendent colon (12.1%), descendent colon (11.2%), and 5.6% of the cases presented association of two colon tumors (synchronic tumors). The surgical treatment was: tumor resection with colostomy (85%), tumor resection with primary anastomosis (10.3%), and colostomy without tumor resection (4.7%). Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p > 0.05%). Conclusions colorectal cancer may be the cause of colon obstruction or perfuration in patients with nonspecific colonic complaints. Despite the high mortality rate, resection of tumor is feasible in most patients.

Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study

“…The mortality rate was 34%, and septic shock was the leading cause of death. When analyzing the subset of patients older than 60 years, almost half died 10. In our report, despite inclusion of older patients and an approximately 50% rate of primary anastomosis, the mortality rate was lower.…”

“…Emergency surgery has a direct impact on results. There are higher postoperative complication and mortality rates with emergency surgery than with elective surgery, reaching 33.6-64% and 20-34%, respectively 8-10. Moreover, old age is considered a risk factor for emergency surgery in patients with colorectal cancer 11,12.…”

Colon cancer surgery in patients operated on an emergency basis

“…This fact is explained not only by the patients' deterioration of the clinical status due to the obstructive emergency condition, but also by the advanced stage of the tumor found in such situations 6 . Perforation can occur in 3% to 8% of cases 8 , and although it is a more serious condition and presents greater postoperative morbidity and mortality than colonic obstruction 5 , survival rates are similar in both situations 9 .…”

“…Although it is a cancer type with a relatively good prognosis, mainly due to the natural history, its overall mortality remains high in Brazil 11 , especially in those patients operated on as an emergency 8 . This reflects the failure of CRC screening policies, with the diagnosis often made in advanced stages, with complications such as obstruction and perforation.…”